Gaude p, vedel p, larsen n, jensen gvh, parving h, pedersen o. The accord action to control cardiovascular risk in. Atherosclerotic cardiovascular disease is increased severalfold in most patients with type 2 diabetes, particularly patients who are older and have other risk factors 1,2. Favorite five articles from recent medical journals. In brief management of individuals with type 2 diabetes involves complex decisionmaking to attain good glycemic control. Effects of aspirin for primary prevention in persons with diabetes mellitus. In brief cardiovascular disease is the leading cause of morbidity and mortality in people with diabetes, and deaths from heart disease are two to four times higher among adults with type 2 diabetes.
A personalized approach to the care of these individuals provides a unique management plan for each patient. Intensive glucose control increased mortality and did. Citescore values are based on citation counts in a given year e. Hypertension is a common co morbidity in patients with type 2 diabetes. This study included 3 selfreported white subjects from this ancillary study 24, who were also. These associated risk factors include hypertension, obesity, and dyslipidemia. The costeffectiveness of screening for type 2 diabetes, cdc diabetes costeffectiveness study group, centers for disease control and prevention. A comparison of the effect of a targeted, intensified, multifactorial intervention with that of conventional treatment on risk factors for. And in this trial there was a positive result with a 33% reduction in progression of retinopathy in patients who were. Participants were assigned to intensive or standard therapy target hba 1c less than 42 or 5363 mmolmol less than 60% or 7079%, respectively. The action to control cardiovascular risk in diabetes study group epidemiologic studies have shown a relationship between glycated hemoglobin levels and cardiovascular events in patients with. Diabetic dyslipidemia, which has also been called atherogenic dyslipidemia a term that describes the lipid abnormalities in people with. Prospective diabetes study, accord action to control cardiovascular risk in diabetes, advance action in diabetes and vascular disease.
You can also register with journals to receive email alerts about their latest publications and content. These associated risk factors include hypertension. A total of 10,096 accord study participants with followup for both hypoglycemia and mortality were included. Patients with type 2 diabetes have a high rate of cardiovascular disease cvd mortality, nonfatal myocardial infarction mi, and stroke. Finally, the results of the accord trial should also be compared with the 10year followup of the approximately 10year united kingdom prospective diabetes study ukpds trial, which tested the effect of intensive glycemia management during the active phase of the trial in patients with newly diagnosed type 2 diabetes. Dec 18, 2014 the study, known as the action to control cardiovascular risk in diabetes accord trial, is being conducted at 77 sites in north america. Review article diabetes mellitus a devastating metabolic. Diabetes can also result in microvascular complications such as retinopathy, neuropathy, and nephropathy, which are the leading causes of blindness, nontraumatic foot amputation, and endstage renal disease, respectively.
In the case of fenofibrate, 2 cardiovascular end point trials conducted within the last decade failed to show benefit with administration of fenofibrate in patients with type 2 diabetes either alone in the field study 24 or as addon therapy to statin in the accord study. The new engl and journal of medicine 2546 n engl j med 358. Effects of intensive glucose lowering in type 2 diabetes nejm. Accord was a randomized trial conducted at 77 clinical sites organized into seven networks in the united states and canada for a full list of participating institutions and investigators, see section 1 in supplementary appendix 1, available with the full text of this article at. People with type2 diabetes, high hba1c concentrations 7. Table 1 provides a summary of baseline characteristics, glycemic treatment strategies and goals, concomitant risk factor control, achieved glycemic control, and primary results of each of the three studies. Cardiovascular impact of drugs used in the treatment of diabetes. The accord action to control cardiovascular risk in diabetes lipid trial what we learn from subgroup analyses henry n. The action to control cardiovascular risk in diabetes accord trial was. The accord action to control cardiovascular risk in diabetes. Aggressive bp control significantly reduced the risk of.
The intensified glucose lowering arm of the accord study with 5128 patients with a targeted hba 1c of less than 6% was discontinued when it became apparent that such an intensive regimen resulted in a significantly higher allcause risk of death of 22% and a 35% increase in. It has over 10,000 participants between the ages of 40 and 82 who have been involved with the study for between two and seven years. Multifactorial interventions and cardiovascular disease in patients with type 2 diabetes. Sep 11, 2018 methods the authors used transportability methods to reweight individual patient data from the accord action to control cardiovascular risk in diabetes bp trial n 4,507 of intensive goal systolic bp diabetes data from. Diabetic kidney disease american society of nephrology. Listing a study does not mean it has been evaluated by the u. A journal of the american diabetes association april 2020. Use the following to access and submit articles about diabetes care to leading journals. Randomized controlled trial action to control cardio vascular risk in diabetes accord study. Ginsberg, md a therosclerotic cardiovascular disease is increased severalfold in most patients with type 2 diabetes, particularly patients who are older and have other risk factors 1,2.
The accord lipid trial tested the hypothesis that treatment of patients with type 2 diabetes with fenofibrate to increase plasma hdl cholesterol levels and reduce plasma tg concentrations, on the atherosclerotic cardiovascular disease is increased severalfold in most patients with type 2 diabetes, particularly patients who are older and have other risk factors 1,2. The action to control cardiovascular risk in diabetes accord study randomized 4733 patients with type 2 diabetes for a mean duration of 11 years and hypertension to tight versus standard systolic bp mean achieved, 119 versus 4 mmhg and followed them for an average of 5 years. Type 2 diabetes mellitus is a complex disease characterized by hyperglycemia, insulin resistance, and variable degrees of insulin deficiency. The impact of frequent and unrecognized hypoglycemia on. Development of a risk score for atrial fibrillation in adults. Some of the media coverage of the accord trial findings has been alarmist, but it is important to note that the trial is looking at a specific, highrisk group of people and that its findings may not be generalizable to all people with diabetes. Fenofibrate therapy and cardiovascular risk in statintreated. Effects of intensive glucose lowering in type 2 diabetes ncbi. Diabetes mellitus increases the risk of cardiovascular disease by a factor of two to. The action to control cardiovascular risk in diabetes study group. Jdc also publishes articles on physiological and molecular aspects of glucose homeostasis. Effects of intensive bloodpressure control in type 2 diabetes mellitus. It is therefore now appropriate to take stock and consider the clinical implications of these results.
Accordmind study the accord memory in diabetes accordmind study included 2,977 participants from the overall accord trial, and 562 of these participants, with available serum samples, participated in an ancillary biomarker study 23. We assessed 10 251 adults aged 4079 years with established type 2 diabetes, mean glycated haemoglobin a 1c hba 1c concentration of 67 mmolmol 83%, and risk factors for ischaemic heart disease enrolled in the accord trial. Accordbp blood pressure investigated whether reducing systolic blood pressure to study reported lack of significant. In the accord bp trial, compared with combined standard treatment. The accord randomized trial diabetes care american. The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes. In this randomized study, 10,251 patients mean age, 62. Stoffers 508 remnantsofthetriglyceriderichlipoproteins, diabetes. Action to control cardiovascular risk in diabetes accord.
The accord blood pressure trial should provide the first definitive clinical trial data on. This manuscript was prepared using accord research materials obtained from the nhlbi biologic specimen and data repository information coordinating center and does not necessarily reflect the opinions or views of the accord researchers or the nhlbi. Accord study group and accord eye study group, effects of medical therapies on retinopathy progression in type 2 diabetes. Clinical implications of the accord trial the journal of. Most downloaded journal of diabetes and its complications. Motsingerreif,7 he gao,1,2 laura lovato,8 sabrina prudente,9 assunta pandolfi,10 marcus g. The accord study was a maximum effort to determine whether treating three major risk factors as intensively as possible hyperglycemia, hypertension, and the triglyceride tg. Estimating the microvascular benefits of screening for type 2 diabetes mellitus.
The accord study group, effects of intensive bloodpressure control in type 2 diabetes mellitus, new england journal of medicine, vol. We present here the main results of the accord bp trial. Hazard ratios 95% cis relating the risk of death to the updated annualized number of hypoglycemic episodes and the updated annualized number of intervals with unrecognized hypoglycemia were obtained using cox proportional hazards regression models. The action to control cardiovascular disease in diabetes accord study has completed its full 5yr planned followup, and all main results have been published 14. Pdf abstract the action to control cardiovascular risks in diabetes study accord. Journal of diabetes and its complications jdc is a journal for health care practitioners and researchers, that publishes original research about the pathogenesis, diagnosis and management of diabetes mellitus and its complications. Should aspirin be used for primary prevention in the poststatin era. The accord study was funded by the national institutes of health.
Type 2 diabetes accounts for more than 90% of patients with diabetes and leads to microvascular and macrovascular complications that cause profound psychological and physical distress to both patients and carers and put a huge burden on healthcare systems. Generalizing intensive blood pressure treatment to adults. The new england journal of medicine n engl j med 362. The accord study was a maximum effort to determine whether. The primary microvascular outcome of the trial was tested with 2856 study participants in the accord eye study by measuring whether the progression of diabetic retinopathy could be prevented. Study design using data from the accord bp trial,1,3 we assessed the effects of intensive bp treatment in patients receiving standard or intensive glycemic control.
A journal of the american diabetes association april 2020 volume 69, number 4 in this issue 497 in this issue of diabetes perspectives in diabetes 499 stressinduced translational regulation mediated by rna binding proteins. Clinical implications of the accord trial the journal of clinical. Whether the mortality increase in accord was resultant to the trials. They also experience increased rates of nonfatal myocardial infarction and stroke. Publishing your improvement and learning through journals can also help others drive change. Type 1 diabetes is said to account for only a minority of the total burden of diabetes in a population although it is the major type of the diabetes in younger age groups at majority of welltodo countries. The trial enrolled 10,251 highrisk participants with type 2 diabetes mellitus.
Diagnosis and management of type 2 diabetic kidney disease. Most patients with type 2 diabetes mellitus develop cardiovascular disease cvd, with substantial. What did the accord, advance, and va diabetes trials show. Action to control cardiovascular risk in diabetes accord accord the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Accord eye study in addition, there was another substudy of the accord trial called the accord eye study, which took a small subgroup of patients and looked at factors that contributed toward progression of diabetic retinopathy. Effects of intensive bloodpressure control in type 2. Design of the cooperative study on glycemic control and complications in diabetes mellitus type 2. Type 2 diabetes mellitus and hypertension ahaasa journals.
The action to control cardiovascular risk in diabetes accord trial sought to explore whether more intensive glucose control regimens were associated with better outcomes in patients with type 2 diabetes mellitus. Prior to the accord trial, several randomized controlled trials had been conducted regarding blood sugar control in. Effects of intensive glucose lowering in type 2 diabetes. Accord action to control cardiovascular risk in diabetes. Journals are a great way to learn about how others are improving diabetes care in the uk and across the world. Findings from accordlipid mario luca morieri,1,2,3 hetal s. Accord diabetes trial intensive versus standard a1c targets. The detailed protocol, study design, and patients characteristics of the accord trial have been previously reported. The accord action to control cardiovascular risk in diabetes study was a randomized trial done in 77 clinical sites in north america. In fact, another study published this week in the new england journal of medicine showed a reduction. The accord study randomized 10,251 participants with either history of a cvd event aged 4079 years or significant cvd risk. Diabetic kidney disease develops in approximately 40% of patients who are diabetic and is the leading cause of ckd worldwide. Effects of intensive glycaemic control on ischaemic heart.
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