Progression of retinopathy in persons with type 2 diabetes: new data, same conclusions?

The ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial was designed primarily to examine the effects of intensive glycemic control on cardiovascular events in persons with type 2 diabetes who were, for additional reasons, at high risk for such events. The trial also examined effects on the same endpoints of intervention on blood pressure and on serum lipids. The study intervention on glycemic control was stopped early because of the effects of this intervention on mortality. The trial provided important data on the effects of the various interventions on diabetic retinopathy, confirming the importance of intensive glycemic control in diminishing the progression of retinopathy. In addition, it provided evidence of a protective effect of fenofibrate treatment on the same retinopathy endpoint. However, the apparent paradoxical effects of intensive glycemic control on macrovascular and microvascular disease suggests caution in the care of persons with type 2 diabetes who are judged to be at high risk for cardiovascular events.