Effects of Intensive Glucose Lowering in the Management of Patients With Type 2 Diabetes Mellitus in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial

trial was designed to test whether treatment targeting nearly normal glycemic control reduces the risk of cardiovascular events in type 2 diabetes mellitus. This aim was based on consistent epidemiological evidence that higher glucose and hemoglobin A 1c (HbA 1c ) levels are associated with greater cardiovascular risk, together with inconclusive results from smaller and shorter interventional studies. 1 All 10 251 participants in ACCORD were randomized to either a standard treatment strategy that targeted HbA 1c levels between 7% and 7.9% or an intensive strategy that sought to attain an HbA 1c 6.0%. With each strategy, investigators could prescribe any antihyperglycemic agent approved by regulatory authorities. The median HbA 1c with the standard strategy was 7.5%; the intensive strategy achieved a median HbA 1c of 6.4%. 2 However, the intensive strategy was stopped after a median follow-up of 3.4 years, 60% of that planned, because of 22% higher all-cause mortality. 2 Participants previously using the intensive strategy were switched to the standard strategy and continued in the trial. The cardiovascular and microvascular effects after the full 5 years of follow-up will soon be reported. Meanwhile, debate continues as to why there was higher mortality with intensive treatment and the clinical implications. Several analyses of the data obtained during randomized treatment have shed light on these issues.