Factors associated with failure to achieve a glycated haemoglobin target of <8.0% in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.
Factors associated with failure to achieve a glycated haemoglobin target of <8.0% in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.
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DOI：
10.1111/dom.12569
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发表时间：
2016-01
期刊：
影响因子：
--
通讯作者：
Seaquist ER
中科院分区：
文献类型：
--
作者：
Drake TC;Hsu FC;Hire D;Chen SH;Cohen RM;McDuffie R;Nylen E;O'Connor P;Rehman S;Seaquist ER
本研究的目的是确定控制糖尿病心血管风险行动 (ACCORD) 血糖试验标准治疗组中未能达到糖化血红蛋白 (HbA1c) 目标的参与者的临床特征。我们分析了标准治疗组的 4685 名参与者，将随机分组后 12 个月达到 HbA1c 目标 <8.0% 的参与者与 HbA1c 水平≥8.0% 的参与者进行比较。比较基线和 12 个月的临床特征。随机分组后 12 个月时，3194 名参与者的 HbA1c <8.0%，1491 名参与者的 HbA1c ≥8.0%。黑人种族 [比值比 (OR) 0.74，95% 置信区间 (CI) 0.61–0.89；在调整模型中，严重低血糖（OR 0.57，CI 0.37-0.89；p = 0.014）和胰岛素使用（OR 0.51，CI 0.40-0.65；p < 0.001）与调整模型中 12 个月未能达到 HbA1c 目标相关。即使采用免费药物、免费就诊临床医生和积极调整药物剂量，ACCORD 试验标准组中超过 30% 的参与者在 1 年时的 HbA1c ≥8.0%。按照标准方案 12 个月后，患有严重低血糖且使用胰岛素的黑人参与者的 HbA1c 浓度更有可能高于目标值。
The aim of this study was to identify the clinical features of participants in the standard therapy arm of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) glycaemia trial who failed to reach the glycated haemoglobin (HbA1c) target. We analysed 4685 participants in the standard therapy arm, comparing participants who reached the HbA1c target of <8.0% with those whose HbA1c level was ≥8.0% 12 months after randomization. Baseline and 12-month clinical characteristics were compared. At 12 months after randomization, 3194 participants had HbA1c <8.0% and 1491 had HbA1c ≥8.0%. Black race [odds ratio (OR) 0.74, 95% confidence interval (CI) 0.61–0.89; p = 0.002], severe hypoglycaemia (OR 0.57, CI 0.37–0.89; p = 0.014) and insulin use (OR 0.51, CI 0.40–0.65; p < 0.001) were associated with failure to reach HbA1c goal at 12 months in the adjusted model. Even with free medications, free visits with clinicians and aggressive titration of medications, >30% of participants in the standard arm of the ACCORD trial had an HbA1c ≥8.0% at 1 year. Participants who were black, had severe hypoglycaemia and were on insulin were more likely to have an above-target HbA1c concentration after 12 months on the standard protocol.
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