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Factors associated with failure to achieve a glycated haemoglobin target of <8.0% in the Action to Control

T C Drake1, F-C Hsu2, D Hire2

  • 1Division of Endocrinology and Diabetes, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.

Diabetes, Obesity & Metabolism
|October 6, 2015
PubMed

Insights

Over 30% of participants in the ACCORD trial standard therapy arm did not reach their glycated haemoglobin (HbA1c) goal. Black race, severe hypoglycemia, and insulin use were linked to higher HbA1c levels.

Area of Science:

  • Endocrinology
  • Clinical Medicine
  • Diabetes Research

Background:

  • The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial investigated intensive glycemic control.
  • Understanding factors associated with treatment failure is crucial for optimizing diabetes management.

Purpose of the Study:

  • To identify clinical features of participants in the ACCORD standard therapy arm who failed to achieve the target glycated haemoglobin (HbA1c) level.
  • To analyze predictors of not reaching HbA1c <8.0% after 12 months of standard treatment.

Main Methods:

  • Analysis of 4685 participants in the ACCORD standard therapy arm.
  • Comparison of baseline and 12-month clinical characteristics between participants who reached the HbA1c target (<8.0%) and those who did not (≥8.0%).

Main Results:

  • 1491 participants (approx. 32%) had HbA1c ≥8.0% at 12 months.
  • Black race (OR 0.74), severe hypoglycemia (OR 0.57), and insulin use (OR 0.51) were significantly associated with failure to reach the HbA1c goal in the adjusted model.
  • Despite intensive efforts, over 30% of participants on standard therapy did not meet the glycemic target within one year.

Conclusions:

  • Clinical factors including race, history of severe hypoglycemia, and current insulin use predict failure to achieve glycemic targets in the ACCORD standard therapy arm.
  • These findings highlight the need for personalized strategies to improve glycemic control in diverse patient populations with type 2 diabetes.

Keywords:
antidiabetic drugclinical trialcost-effectivenessdiabetes complicationsinsulin therapytype 2 diabetes

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