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Intensive Glycemic Control and Cardiovascular Disease Observations From the ACCORD Study

Now What Can a Clinician Possibly Think?

¹ Division of Nutrition and Chronic Diseases, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana
² Center for Health Sciences, University of California Los Angeles, Los Angeles, California

Corresponding author: William T. Cefalu, Division of Nutrition and Chronic Diseases, Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Rd., Baton Rouge, LA 70808. E-mail: cefaluwt@pbrd.edu

Abbreviations: ACCORD, Action to Control Cardiovascular Risk in Diabetes; ADVANCE, Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation

The first 300 words of the full text of this article appear below.

It goes without saying that the results of randomized clinical trials over the past few years evaluating specific diabetic regimens have been nothing short of surprising. For example, with specific regard to the use of thiazolidinediones, all the data up to the point of conducting randomized, controlled clinical trials for hard cardiovascular outcomes suggest that these agents would more than fulfill their promise to reduce clinical events. Specifically, the effects of these drugs on the surrogate markers, e.g., endothelial function, coagulopathy, and inflammation, all favored a strong clinical result. What was found in clinical studies that assessed hard end points was less than impressive. Interestingly, the expected favorable outcomes with use of thiazolidinediones were not routinely seen, and in some studies and using certain agents, the observation was made that event rates increased. Now, more recently, come the startling findings that intensive glycemic control in a high-risk cohort failed to live up to its promise in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Surprising? Yes! Unexpected? Certainly! Will the findings really impact clinical recommendations and have far reaching implications? We will first need to take a step back and evaluate the study more carefully, and we will only be in a position to suggest changes to current clinical recommendations after the dust settles.

There is no question regarding the benefit of glycemic control in reducing the progression and development of microvascular complications in subjects with type 1 and type 2 diabetes. But, with all data considered, there has been a question of whether glycemic control will have a major impact on cardiovascular disease or all-cause mortality. In this regard, data have clearly demonstrated that hyperglycemia may predict a higher likelihood of fatal and nonfatal cardiovascular events. Studies such as the Diabetes Control and Complication Trial/Epidemiology of Diabetes . . . [Full Text of this Article]

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