ACCORD Diabetes Trial – Intensive versus …协议糖尿病试验密集型和u2026.pdfVIP

RxFiles.ca - Trial Summary (a supplement to the preliminary Feb 08, 2008) L. Regier, B. Jensen - June 12, 2008 1 ACCORD Diabetes Trial – Intensive versus Standard A1C Targets in T2DM { Mortality with a very intensive glucose lowering strategy in high CV risk T2DM patients} UPDATE: Trial now published - NEJM online - June 06, 2008 . This provides further discussion now that the full publication is available. Preliminary trial results causing halting of trial discussed February 2008. Research Question:  This randomized control trial (RCT) sets out to test if there is a correlation between A1C and cardiovascular (CV) events, which has been hypothesized based on epidemiologic studies. {RCTs are a higher quality evidence than epidemiologic studies}  In type 2 diabetes patients who have established CV disease or additional CV risk factors, does an intensive glycemic control strategy to target an A1C 6% decrease cardiovascular risk compared to a standard strategy to target an A1C of 7-7.9%? Trial Methodology  Who was in the trial? n=10,251; type 2 diabetes (T2DM); mean age 62.2yrs; mean A1C of 8.3%; 38% ; ~93.5kg BMI=32 o Inclusion: T2DM; A1C 7.5%; age 40-79yrs with CV disease ~35% or age 55-79 with anatomical evidence of significant atherosclerosis, albuminuria, left ventricular hypertrophy, or at least 2 additional CV risk factors (lipid, hypertension, current smoker or obesity). o Exclusion: frequent/recent hypoglycemia, unwilling to do home glucose monitoring or inject insulin, BMI 45, SCr 133umol/L, other serious illness o 50 patients lost to follow up 162 patients withdrew consent; fairly equally divided between groups, but slightly more in intensiv