Long-term followup of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial has once again failed to support routine intensive glucose lowering in high risk type 2 diabetics. In 2008, as reported in the New England Journal of Medicine, the intensive glucose lowering regimen (target glycated hemoglobin levels <6%) was terminated early after an increase in mortality was observed in that group, and all patients received standard glucose control therapy (target glycated hemogloblin level of 7-7.9%).
Now a new paper in the New England Journal of Medicine reports the 5 year results of the trial, after 3.7 years of intensive glucose lowering treatment and up to 17 months of additional followup. Mortality at 5 years was 19% higher at 5 years in the intensive control group (7.6% in the intensive therapy group versus 6.4% in the standard therapy group). By contrast, the incidence of nonfatal myocardial infarction was lower in the intensive therapy group, although cardiovascular deaths were higher in this group.
In their conclusion, the ACCORD investigators write that the results “suggest a lower limit for glycemic targets, achieved with the use of multiple combinations of currently available approaches.”
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