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Clinical implications of the ACCORD trial
1Case Western Reserve University, Division of Clinical and Molecular Endocrinology, Department of Medicine, Cleveland, Ohio 44106-4951, USA. smg@cwru.edu
The Journal of Clinical Endocrinology and Metabolism
|November 4, 2011
Summary
Intensive glycemic control in type 2 diabetes patients did not reduce cardiovascular disease (CVD) risk and increased mortality. Fenofibrate and intensive blood pressure control showed some benefits, but intensive glucose management is rarely justified.
Area of Science:
- Cardiovascular Medicine
- Endocrinology
- Clinical Trials
Background:
- The Action to Control Cardiovascular Risk in Type 2 Diabetes (ACCORD) trial evaluated intensive vs. standard glycemic control, blood pressure control, and fenofibrate vs. placebo.
- All patients received background statin therapy.
Purpose of the Study:
- To assess the efficacy of intensive glycemic control, intensive blood pressure control, and fenofibrate on cardiovascular disease (CVD) outcomes in type 2 diabetes patients.
- To analyze the impact of these interventions on overall mortality and microvascular outcomes.
Main Methods:
- Double factorial randomized clinical trial design.
- Comparison of intensive versus standard treatment strategies for glycemic and blood pressure control.
- Addition of fenofibrate versus placebo in patients on statin therapy.
Main Results:
- The primary composite CVD outcome was not reduced by intensive glycemic or blood pressure control, nor by fenofibrate addition.
- Intensive glycemic control was associated with increased total mortality.
- Secondary CVD and microvascular outcomes showed some benefits with more aggressive treatments.
- Severe hypoglycemia was a risk factor for mortality and more frequent in the intensive glycemic group.
Conclusions:
- Intensive glycemic therapy is rarely justified in ACCORD-type patients due to increased mortality risk.
- Intensive blood pressure treatment and fenofibrate addition to statin therapy may be warranted in selected cases.
- The ACCORD trial yielded complex findings requiring careful interpretation for clinical practice.
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