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Nine-Year Effects of 3.7 Years of Intensive Glycemic Control on Cardiovascular Outcomes

    Diabetes Care
    |January 30, 2016
    PubMed

    Insights

    Intensive glycemic control in type 2 diabetes did not improve long-term cardiovascular outcomes or reduce overall mortality. However, it did not increase cardiovascular death during prolonged follow-up.

    Area of Science:

    • Cardiology
    • Endocrinology
    • Diabetes Research

    Background:

    • The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial investigated intensive versus standard glycemic control in type 2 diabetes.
    • The initial ACCORD trial showed neutral effects on cardiovascular outcomes but increased mortality.

    Purpose of the Study:

    • To analyze the long-term effects of intensive glycemic control initiated during the ACCORD trial.
    • To evaluate cardiovascular and mortality outcomes during prolonged follow-up after the ACCORD trial.

    Main Methods:

    • Utilized data from the ACCORD Follow-on (ACCORDION) study, including surviving participants from the original ACCORD trial.
    • Employed an intention-to-treat approach, analyzing outcomes based on original group allocation.
    • Prospectively collected cardiovascular and other health-related outcomes over a median follow-up of 8.8 years.

    Main Results:

    • Intensive glucose lowering for 3.7 years had a neutral long-term effect on the primary composite cardiovascular outcome and all-cause death.
    • The increased cardiovascular mortality observed during the active ACCORD trial phase significantly decreased during the follow-up period.
    • No significant increase in cardiovascular-related death was observed during the prolonged follow-up in the intensive glycemic control group.

    Conclusions:

    • In high-risk individuals with type 2 diabetes, intensive glycemic control for approximately 3.7 years had a neutral long-term impact on major cardiovascular events and overall mortality.
    • While initial findings showed increased cardiovascular mortality, this risk diminished during extended follow-up, suggesting a complex relationship between glycemic control intensity and cardiovascular risk.
    Abstract

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