title: Nine-Year Effects of 3.7 Years of Intensive Glycemic Control on Cardiovascular Outcomes.
abstract: In the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, ∼4 years of intensive versus standard glycemic control in participants with type 2 diabetes and other cardiovascular risk factors had a neutral effect on the composite cardiovascular outcome, increased cardiovascular and total mortality, and reduced nonfatal myocardial infarction. Effects of the intervention during prolonged follow-up were analyzed.
  
  
  
  All surviving ACCORD participants were invited to participate in the ACCORD Follow-on (ACCORDION) study, during which participants were treated according to their health care provider's judgment. Cardiovascular and other health-related outcomes were prospectively collected and analyzed using an intention-to-treat approach according to the group to which participants were originally allocated.
  
  
  
  A total of 8,601 people, representing 98% of those who did not suffer a primary outcome or death during the ACCORD trial, were monitored for a median of 8.8 years and a mean of 7.7 years from randomization. Intensive glucose lowering for a mean of 3.7 years had a neutral long-term effect on the primary composite outcome (nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death), death from any cause, and an expanded composite outcome that included all-cause death. Moreover, the risk of cardiovascular mortality noted during the active phase (hazard ratio 1.49; 95% CI 1.19, 1.87; P < 0.0001) decreased (HR 1.20; 95% CI 1.03, 1.39; P = 0.02).
  
  
  
  In high-risk people with type 2 diabetes monitored for 9 years, a mean of 3.7 years of intensive glycemic control had a neutral effect on death and nonfatal cardiovascular events but increased cardiovascular-related death.
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents
references.citation: Diabetologia. 2014 Oct;57(10):2030-7
references.pmid: 24985147
references.citation: Lancet Diabetes Endocrinol. 2013 Sep;1(1):71-8
references.pmid: 24622269
references.citation: Diabetes Care. 2005 Jan;28 Suppl 1:S4-S36
references.pmid: 15618112
references.citation: N Engl J Med. 2008 Jun 12;358(24):2545-59
references.pmid: 18539917
references.citation: Diabetes Care. 2010 Apr;33(4):721-7
references.pmid: 20103550
references.citation: N Engl J Med. 2015 Jun 4;372(23):2197-206
references.pmid: 26039600
references.citation: N Engl J Med. 2009 Jan 8;360(2):129-39
references.pmid: 19092145
references.citation: Clin Trials. 2008;5(1):56-60
references.pmid: 18283081
references.citation: Diabetes Care. 2010 Dec;33(12):2719-21
references.pmid: 21115777
references.citation: Diabetes Care. 2015 Nov;38(11):2000-8
references.pmid: 26464212
references.citation: Lancet. 2014 Nov 29;384(9958):1936-41
references.pmid: 25088437
references.citation: Control Clin Trials. 1986 Sep;7(3):177-88
references.pmid: 3802833
references.citation: Diabetes Care. 2015 Jun;38(6):1067-74
references.pmid: 25887355
references.citation: N Engl J Med. 2011 Mar 3;364(9):818-28
references.pmid: 21366473
references.citation: Stat Med. 2002 Jun 15;21(11):1539-58
references.pmid: 12111919
references.citation: Diabetes Care. 2010 May;33(5):983-90
references.pmid: 20427682
references.citation: BMJ. 2010 Jan 08;340:b4909
references.pmid: 20061358
references.citation: Clin Trials. 2009 Jun;6(3):239-51
references.pmid: 19528133
references.citation: N Engl J Med. 2010 Apr 29;362(17):1575-85
references.pmid: 20228401
references.citation: Am J Cardiol. 2007 Jun 18;99(12A):21i-33i
references.pmid: 17599422
references.citation: Lancet. 1998 Sep 12;352(9131):837-53
references.pmid: 9742976
references.citation: Diabetes Care. 2010 Jul;33(7):1578-84
references.pmid: 20215456
references.citation: N Engl J Med. 2010 Jul 15;363(3):233-44
references.pmid: 20587587
references.citation: N Engl J Med. 2010 Apr 29;362(17):1563-74
references.pmid: 20228404
references.citation: Diabetes Care. 2014;37(3):634-43
references.pmid: 24170759
references.citation: Can J Diabetes. 2013 Apr;37 Suppl 1:S1-3
references.pmid: 24070926
references.citation: N Engl J Med. 2008 Oct 9;359(15):1577-89
references.pmid: 18784090
references.citation: Diabetologia. 2009 Nov;52(11):2288-98
references.pmid: 19655124
references.citation: N Engl J Med. 2008 Jun 12;358(24):2560-72
references.pmid: 18539916
references.citation: N Engl J Med. 2014 Oct 9;371(15):1392-406
references.pmid: 25234206