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Glycemia treatment strategies in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.
Am J Cardiol 2007; 99(12A):34i-43iAJ

Abstract

There is an independent progressive epidemiologic relation between glycemia and cardiovascular disease (CVD) events; however, whether lowering glucose levels with currently available therapies can reduce CVD events remains unknown. The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial is designed to answer this question in high-risk patients with type 2 diabetes mellitus. In ACCORD, 10,251 patients with type 2 diabetes and other CVD risk factors or CVD were randomly allocated to intensive glycemic control, targeting a glycosylated hemoglobin (HbA1c) level <6%, or standard glycemic control, targeting an HbA1c level of 7.0%-7.9%. All participants are provided with diabetes education, glucose-monitoring equipment, and antidiabetic medications. All participants in the intensive glycemic control group are started on > or = 2 classes of agents. Doses are intensified or a new medication class is added every month if HbA1c levels are > or = 6% or if >50% of premeal or postmeal capillary glucose readings are >5.6 mmol/L (100 mg/dL) or >7.8 mmol/L (140 mg/dL), respectively. All drug combinations are permitted, and drugs are reduced only because of side effects or contraindications. Annual training, menus of approaches for intensification, regular electronic messaging, audits of achieved glycemia, and central feedback to sites support glycemic intensification strategies in intensive participants. In participants in the standard glycemic control group, therapy is intensified whenever HbA1c is > or = 8%, and antihyperglycemic drugs that promote hypoglycemia (ie, insulin or insulin secretagogues) are reduced if HbA1c persistently decreases to <7% in the setting of hypoglycemia. ACCORD addresses the hypothesis that aggressive glucose lowering prevents CVD events in patients with type 2 diabetes. It is focused on the levels of glycemia achieved using a variety of strategies, not on the specific therapies used. It will also provide information on how to safely approach near-normal levels of glucose control in clinical practice and evidence to support future clinical guidelines for diabetes management in older adults.

Authors+Show Affiliations

Department of Medicine and the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada. gerstein@mcmaster.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

17599423

Citation

Gerstein, Hertzel C., et al. "Glycemia Treatment Strategies in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial." The American Journal of Cardiology, vol. 99, no. 12A, 2007, pp. 34i-43i.
Gerstein HC, Riddle MC, Kendall DM, et al. Glycemia treatment strategies in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Am J Cardiol. 2007;99(12A):34i-43i.
Gerstein, H. C., Riddle, M. C., Kendall, D. M., Cohen, R. M., Goland, R., Feinglos, M. N., ... Feeney, P. (2007). Glycemia treatment strategies in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. The American Journal of Cardiology, 99(12A), pp. 34i-43i.
Gerstein HC, et al. Glycemia Treatment Strategies in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial. Am J Cardiol. 2007 Jun 18;99(12A):34i-43i. PubMed PMID: 17599423.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Glycemia treatment strategies in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. AU - Gerstein,Hertzel C, AU - Riddle,Matthew C, AU - Kendall,David M, AU - Cohen,Robert M, AU - Goland,Robin, AU - Feinglos,Mark N, AU - Kirk,Julienne K, AU - Hamilton,Bruce P, AU - Ismail-Beigi,Faramarz, AU - Feeney,Patricia, AU - ,, Y1 - 2007/04/19/ PY - 2007/7/12/pubmed PY - 2007/8/19/medline PY - 2007/7/12/entrez SP - 34i EP - 43i JF - The American journal of cardiology JO - Am. J. Cardiol. VL - 99 IS - 12A N2 - There is an independent progressive epidemiologic relation between glycemia and cardiovascular disease (CVD) events; however, whether lowering glucose levels with currently available therapies can reduce CVD events remains unknown. The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial is designed to answer this question in high-risk patients with type 2 diabetes mellitus. In ACCORD, 10,251 patients with type 2 diabetes and other CVD risk factors or CVD were randomly allocated to intensive glycemic control, targeting a glycosylated hemoglobin (HbA1c) level <6%, or standard glycemic control, targeting an HbA1c level of 7.0%-7.9%. All participants are provided with diabetes education, glucose-monitoring equipment, and antidiabetic medications. All participants in the intensive glycemic control group are started on > or = 2 classes of agents. Doses are intensified or a new medication class is added every month if HbA1c levels are > or = 6% or if >50% of premeal or postmeal capillary glucose readings are >5.6 mmol/L (100 mg/dL) or >7.8 mmol/L (140 mg/dL), respectively. All drug combinations are permitted, and drugs are reduced only because of side effects or contraindications. Annual training, menus of approaches for intensification, regular electronic messaging, audits of achieved glycemia, and central feedback to sites support glycemic intensification strategies in intensive participants. In participants in the standard glycemic control group, therapy is intensified whenever HbA1c is > or = 8%, and antihyperglycemic drugs that promote hypoglycemia (ie, insulin or insulin secretagogues) are reduced if HbA1c persistently decreases to <7% in the setting of hypoglycemia. ACCORD addresses the hypothesis that aggressive glucose lowering prevents CVD events in patients with type 2 diabetes. It is focused on the levels of glycemia achieved using a variety of strategies, not on the specific therapies used. It will also provide information on how to safely approach near-normal levels of glucose control in clinical practice and evidence to support future clinical guidelines for diabetes management in older adults. SN - 0002-9149 UR - https://www.unboundmedicine.com/medline/citation/17599423/Glycemia_treatment_strategies_in_the_Action_to_Control_Cardiovascular_Risk_in_Diabetes__ACCORD__trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(07)00439-0 DB - PRIME DP - Unbound Medicine ER -