Methods study design accord was a randomized trial conducted at 77. A large clinical study designed to determine whether intensively lowering blood glucose levels, intensively lowering blood pressure, or treating blood lipid levels could reduce the risk of heart attack, stroke, or death in people with type 2 diabetes. Action to control cardiovascular risk in diabetes accord. Effects of intensive bloodpressure control in type 2. In this randomized study, 10,251 patients mean age, 62. Treatment in accord ended in 2009 and accordion is designed to further elucidate and clarify the long. Accord blood sugar treatment strategy telebriefing february 06, 200810.
Rational goalsetting and management of diabetes in the elderly. At present, the relationship between adm intake including insulin injection and oral amd and incidence of macu lar edema is still unclear. Module 7 drug treatment in type 2 diabetes with hypertension. The accord action to control cardiovascular risk in. Read about the role of gastric bypass surgery in managing type 2 diabetes and obesity on page 8. The accord study is a federally funded clinical study designed to figure out whether extremely tight blood glucose control reduces heart attacks and other cardiac problems in diabetics. People with diabetes, high hba 1c concentrations 75%, and cardiovascular disease or. Accord study in the action to control cardiovascular risk in diabetes accord study, 10251 adults with type 2 diabetes mean age, 62 years. Effects of intensive glycaemic control on ischaemic heart. The design of the active portion of our study and the main results were published previously. In addition, accord participants had blood sugar levels that were higher than most type 2 diabetes patients in the u. Accord action to control cardiovascular risk in diabetes. Actions to control cardiovascular risk in diabetes accord eye study type 2 diabetes 2003 2009 three medical therapies n10,251. Some, but not all, studies have shown that lowering hba 1c levels reduces cardiovascular risk, and these data have been used to support current guidelines that recommend a target hba 1c level of.
Review article antidiabetic medications and risk of. This appendix has been provided by the authors to give readers additional information about their work. Kdoqi clinical practice guideline for diabetes and ckd. In the accord trial, intensive treatment of patients with type 2 diabetes and high cardiovascular cv risk was associated with higher allcause. For almost 40 years, there has been evidence that intensive lowering of glucose levels in patients with type 2 diabetes mellitus dm can lead to. Type 2 diabetes mellitus is a metabolic disease that is diagnosed on the basis of sustained hyperglycemia. The action to control cardiovascular risk in diabetes accord study was a large, multicentre, prospective, randomised, controlled trial that was supported by the us national heart, lung and blood institute, the national institute of diabetes and digestive and kidney diseases, the national eye institute and the centers for disease control and. The accord lipid trial used fenofibrate because 1 data from the fenofibrate intervention and event lowering in diabetes field trial indicated that the risk of myositis when fenofibrate was combined with a statin was negligible. Accord is one of the largest studies ever conducted in adults with type 2 diabetes who were at especially high risk of cardiovascular events, such as heart attacks, stroke, or death from cardiovascular disease. Effects of combination lipid therapy in type 2 diabetes mellitus. Accord diabetes trial intensive versus standard a1c targets. In the hypertension optimal treatment hot study, there was a 51% reduction in cardiovascular events in diabetics with target diastolic bp diabetes accord blood pressure trial accord bp 4 tested the effect of a target systolic blood pressure below 120 mm hg on ma jor cardiovascular events among highrisk persons with type 2 diabetes. This randomized control trial rct sets out to test if there is a correlation between. The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes.
Implications for patients with type 2 diabetes harlan m. To be eligible for the study, participants also had known heart disease or at least. Study microvascular cvd mortality ukpds1,2 dcctedic3. In 2008, the results of the glucose control study raised some eyebrows. Prior to the accord trial, several randomized controlled trials had been conducted regarding blood sugar control in. A total of 10,096 accord study participants with followup for both hypoglycemia and mortality were included. People with type 2 diabetes are at elevated risk for a number of serious health problems, including cardiovascular disease, premature death, blindness, kidney failure, amputations, fractures, frailty, depression.
Other studies of the role of blood glucose control in people with type 2 diabetes are still under way. Rational goalsetting and management of diabetes in the. A study investigating a monoclonal antibody to t cells, teplizumab, in preventing type 1. Most patients with type 2 diabetes mellitus develop cardiovascular disease cvd, with substantial loss of. Introduction to the edgar cayce readings on health and healing 5 b.
Edic epidemiology of diabetes interventions and complications. The accord action to control cardiovascular risk in diabetes. The accord bp trial was a study of a treat ment strategy to achieve specific systolic bloodpressure goals, rather than an evaluation of any specific drug regimen. 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. Longterm effects of intensive glucose lowering on cardiovascular outcomes. Nejm 2010 on face value the trial seems to be null on the ability of fenofibrate to improve outcomes in t2dm patients.
Effects of intensive glucose lowering in type 2 diabetes nejm. 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. 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. They also experience increased rates of nonfatal myocardial infarction and stroke. In patients with diabetes, high glycated hemoglobin hba 1c levels are associated with elevated risks for cardiovascular events and death. It has over 10,000 participants between the ages of 40 and 82 who have been involved with the. Accord diabetes trial intensive versus standard a1c targets in. This randomized control trial rct sets out to test if there is a correlation between a1c and cardiovascular cv events.
Effects of intensive glucose lowering in 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. Accord study group and accord eye study group, effects of medical therapies on retinopathy progression in type 2 diabetes. The accord study was a maximum effort to determine whether. What does the news about the accord study mean to you. Apr 22, 2011 the accord lipid trial used fenofibrate because 1 data from the fenofibrate intervention and event lowering in diabetes field trial indicated that the risk of myositis when fenofibrate was combined with a statin was negligible. Racgp the use of fenofibrate in the management of patients. Accord study group and of the writing committee for this report appears in the appendix. Intensive glucose control in patients with type 2 diabetes. The federallyfunded accord study of patients with type 2 diabetes and cardiovascular disease or high risk of cvd randomized patients to intensive therapy, n5,057 target hba1c files, the va death files, and the national death. Clinical sites consent documents are kept at the coordinating center.
Accord was a parallelgroup, randomised trial done in 77 clinical sites in north america. 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. Accord diabetes trial intensive versus standard a1c. Accordion the accord followup study is a prospective, observational followup study of at least 8000 participants who were treated and followed in the action to control cardiovascular risk in diabetes accord trial. The cord study is an australiawide pilot trial which will investigate whether cord blood can be used to prevent or delay the development of type 1 diabetes. Accord which stands for action to control cardiovascular risk in diabetes involved type 2 diabetics at high risk for heart problems. Accord stands for action to control cardiovascular risk in diabetes. The accord lipid therapy trial was designed to test the effect of a therapeutic strategy that uses a fibrate to raise hdlc and lower triglyceride levels and uses a statin for treatment of ldlc reduce the rate of cvd events compared to a strategy that only uses a statin for treatment of ldlc on cardiovascular outcomes in patients with type 2 diabetes that were at high risk for cardiovascular disease. Participants were assigned to intensive or standard therapy target hba 1c less than 42 or 5363 mmolmol less than 60% or 7079%.
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. Insulin dose and cardiovascular mortality in the accord trial. Kingdom prospective diabetes study ukpds has shown an 11% decrease in risk with each 10 mmhg reduction of systolic blood pressure. Type 2 diabetes is much more common and accounts for 9095% of all diabetes. Followup of glycemic control and cardiovascular outcomes. The study, known as the action to control cardiovascular risk in diabetes accord trial, is being conducted at 77 sites in north america. Type 2 diabetes primarily affects adults, however recently type 2 has begun developing in children. General commentary on diabetes by william mcgarey, m. And in this trial there was a positive result with a 33% reduction in progression of retinopathy in patients who were. We present here the main results of the accord bp trial. The cord study can cord blood prevent type 1 diabetes. The dais diabetes atherosclerosis intervention study investigators data a very successful angiographic. We do have previous data with fibrates in diabetics or tghdl axis disorders. The study is being led by associate professor maria craig, a paediatric endocrinologist at the childrens hospital at westmead.
Jensen june 12, 2008 accord diabetes trial1 intensive versus standard a1c targets in t2dm mortality with a very intensive glucose lowering strategy in high cv risk t2dm patients research question. Landmark accord trial finds intensive blood pressure and. However, all the antihy pertensive regimens were to include drug classes that had been shown to result in a reduction in cardiovascular events among participants with diabetes. Action to control cardiovascular risk in diabetes accord trial. Vitamin d to prevent type 2 diabetes the d2d study the primary aim of the d2d study is to determine the effectiveness of vitamin d is preventing type 2 diabetes mellitus. Accord diabetes trial1 intensive versus standard a1c targets in t2dm mortality with a very intensive glucose lowering strategy in high cv risk t2dm patients research question. Clinical implications of the accord trial the journal of clinical. Advance collaborative group, patel a, macmahon s, et al. Since these studies showed for the first time that glycaemic control to targets under 200 mgdl and an hba1c of 7 percent had substantial. Followup of glycemic control and cardiovascular outcomes in.
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