ACCORD Study Shows Mixed Results for Strict Glycemic Control

Intensive control of blood glucose levels reduces the development and progression of certain microvascular complications of type 2 diabetes but does not reduce cardiovascular risk, according to the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study investigators. The results were published recently in The Lancet.

In this randomized controlled trial, patients were treated to a hemoglobin A_1c (HbA_1c) level of 6% or less, or to a level of 7% to 7.9%. Researchers compared rates of dialysis or renal transplantation, high serum creatinine, retinal damage or peripheral neuropathy; 13 secondary outcomes of kidney, eye and peripheral nerve function were also measured.

Strict glycemic control had no effect on overall measures of microvascular outcomes, such as progression rates to kidney failure, major vision loss, or advanced peripheral neuropathy.  However, there were some microvascular improvements noted, such as a reduced incidence of albuminuria in the intensive treatment group, compared with those receiving standard treatment, along with fewer cataract extractions during the study period. Visual acuity and nerve function scores were also better for the intensive group than for the standard-treatment group.

“Patients who develop macroalbuminuria are prone to renal failure and cardiovascular events,” said Faramarz Ismail-Beigi, MD, PhD, of Case Western Reserve University and the lead researcher on this portion of the study. “Less protein in the urine is a very good sign.” Although the visual acuity tests were somewhat subjective, Dr Ismail-Beigi said, they could indicate that intensive glucose lowering helps prevent retinal damage. However, Dr Ismail-Beigi cautioned that despite the microvascular benefits, “overall, targeting of HbA1c of 6.0% or less is not recommended.”