Background
What does ACCORD stand for?
The Action to Control Cardiovascular Risk in Diabetes
What is one of the inclusion criteria?
- T2DM
- A1c of ≥7.5%
- 40-79 years of age with CVD
OR 55-79 years of age with evidence of CV risk factors
What is the primary outcome?
First occurrence of non fatal myocardial infarction or non fatal stroke or death from cardiovascular causes
Which group had higher rates of hypoglycemia, weight gain, and fluid retention?
Intensive therapy group
Why was the study terminated 17 months ahead of schedule?
The harm from increased all-cause mortality associated with the intensive therapy outweighed any potential benefits
What was one health problem associated with type 2 diabetes mellitus mentioned in the study?
CV disease, premature death, blindness, kidney failure, amputations, fractures, frailty, depression, cognitive decline
What is the study design?
Randomized, Double 2x2 factorial
What is secondary outcome that was reported on in the study?
Death from any cause.
Which group experienced a higher rate of nonfatal myocardial infarction?
Standard-therapy group
What was one weakness mentioned in the discussion section?
- Did not evaluate risks and benefits of rapidly lowering A1c compared to slower approaches
- Did not address prevention of increasing A1c
- Did not address prevention of diabetes in general
- Did not evaluate lowering A1c levels in patients without CV issues first
- So many medications were used because glucose-lowering strategies were regulated by providers, not the investigators
What was the ACCORD trial specifically designed to do?
Determine whether an intensive (<6.0%) A1c reduction strategy is superior to a standard (7.0-7.9%) A1c reduction strategy
What is one of the exclusion criteria?
-frequent or serious hypoglycemic events
-unwillingness to do home glucose monitoring or inject insulin
-BMI ≥ 45
-SCr > 1.5 mg/dL
-other serious illness
What power were the investigators aiming to achieve?
89%
Which group experienced greater exposure to drugs from every class?
Intensive-therapy group
What was one strength mentioned in the discussion section?
- Random assignment
- High rate of follow-up and frequency of follow-ups
- Achievement and maintenance of lower A1c levels
- Blinded committee to adjudicate outcomes
- Independent safety auditing
What health outcomes did this study aim to address?
Cardiovascular outcomes
What was one of the statistically significant finding?
- Nonfatal myocardial infarction was more common in standard group
- Death from all causes (including CV causes) was more common in the intensive group
What anti-hyperglycemic therapy could patients take?
*:･ﾟ✧Any✧*:･ﾟ
Which group experienced a higher rate of death from any cause?
Intensive group
What was the number needed to harm?
One death for every 95 patients who were treated for 3.5 years with intensive glucose control