title: Durable change in glycaemic control following intensive management of type 2 diabetes in the ACCORD clinical trial.
abstract: OBJECTIVE
  We aimed to determine the persistence of glycaemic control 1 year after a limited period of intensive glycaemic management of type 2 diabetes.
  
  
  METHODS
  4119 ACCORD Trial participants randomised to target HbA1c <6.0% (42 mmol/mol) for 4.0 ± 1.2 years were systematically transitioned to target HbA1c 7.0-7.9% (53-63 mmol/mol) and followed for an additional 1.1 ± 0.2 years. Characteristics of participants with HbA1c <6.5% (48 mmol/mol) or ≥6.5% at transition were compared. Changes in BMI and glucose-lowering medications were compared between those ending with HbA1c <6.5% vs ≥6.5%. Poisson models were used to assess the independent effect of attaining HbA1c <6.5% before transition on ending with HbA1c <6.5%.
  
  
  RESULTS
  Participants with pre-transition HbA1c <6.5% were older with shorter duration diabetes and took less insulin but more non-insulin glucose-lowering agents than those with higher HbA1c. A total of 823 participants achieved a final HbA1c <6.5%, and had greater post-transition reductions in BMI, insulin dose and secretagogue and acarbose use than those with higher HbA1c (p < 0.0001). HbA1c <6.5% at transition predicted final HbA1c <6.5% (crude RR 4.9 [95% CI 4.0, 5.9]; RR 3.9 [95% CI 3.2, 4.8] adjusted for demographics, co-interventions, pre-intervention HbA1c, BMI and glucose-lowering medication, and post-transition change in both BMI and glucose-lowering medication). Progressively lower pre-transition HbA1c levels were associated with a greater likelihood of maintaining a final HbA1c of <6.5%. Follow-up duration was not associated with post-transition rise in HbA1c.
  
  
  CONCLUSIONS
  Time-limited intensive glycaemic management using a combination of agents that achieves HbA1c levels below 6.5% in established diabetes is associated with glycaemic control more than 1 year after therapy is relaxed.
authors.affiliation: Department of Medicine, McMaster University, 1280 Main St W., Hamilton, ON, L8S 4K1, Canada, zubin.punthakee@mcmaster.ca.
authors.forename: Zubin
authors.initials: Z
authors.lastname: Punthakee
authors.forename: Michael E
authors.initials: ME
authors.lastname: Miller
authors.forename: Debra L
authors.initials: DL
authors.lastname: Simmons
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Riddle
authors.forename: Faramarz
authors.initials: F
authors.lastname: Ismail-Beigi
authors.forename: David J
authors.initials: DJ
authors.lastname: Brillon
authors.forename: Richard M
authors.initials: RM
authors.lastname: Bergenstal
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Savage
authors.forename: Irene
authors.initials: I
authors.lastname: Hramiak
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Largay
authors.forename: Ajay
authors.initials: A
authors.lastname: Sood
authors.forename: Hertzel C
authors.initials: HC
authors.lastname: Gerstein
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000187:drug effects*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents