Effects of intensive glucose lowering in the management of patients with type 2 diabetes mellitus in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.
Effects of intensive glucose lowering in the management of patients with type 2 diabetes mellitus in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.
复制标题
控制糖尿病心血管风险行动 (ACCORD) 试验中强化降糖治疗 2 型糖尿病患者的效果。
DOI：
10.1161/circulationaha.110.960138
复制
发表时间：
2010-08-24
期刊：
影响因子：
37.8
通讯作者：
Riddle MC
中科院分区：
文献类型：
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作者：
Riddle MC
控制糖尿病心血管风险的行动（ACCORD）试验旨在测试以接近正常血糖控制为目标的治疗是否能降低2型糖尿病患者心血管事件的风险。该目的是基于一致的流行病学证据，即较高的葡萄糖和血红蛋白A1c （HbA1c）水平与更高的心血管风险相关，以及来自较小和较短的介入性研究的不确定结果。ACCORD试验的所有10251名参与者被随机分为两组，一组是针对HbA1c水平在7%至7.9%之间的标准治疗策略，另一组是寻求达到HbA1c水平6.0%的强化治疗策略。对于每一种策略，研究人员都可以开出监管机构批准的任何抗高血糖药物。标准方案的中位HbA1c为7.5%；强化策略使HbA1c中位数达到6.4%。然而，由于全因死亡率增加22%，强化策略在中位随访3.4年后停止，占计划随访时间的60%。先前使用密集策略的参与者被转换为标准策略并继续进行试验。5年随访后的心血管和微血管效果将很快报告。与此同时，关于为什么强化治疗和临床意义会导致更高的死亡率的争论仍在继续。对随机治疗期间获得的数据进行的几项分析揭示了这些问题。
The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial was designed to test whether treatment targeting nearly normal glycemic control reduces the risk of cardiovascular events in type 2 diabetes mellitus. This aim was based on consistent epidemiological evidence that higher glucose and hemoglobin A1c (HbA1c) levels are associated with greater cardiovascular risk, together with inconclusive results from smaller and shorter interventional studies. 1 All 10 251 participants in ACCORD were randomized to either a standard treatment strategy that targeted HbA1c levels between 7% and 7.9% or an intensive strategy that sought to attain an HbA1c 6.0%. With each strategy, investigators could prescribe any antihyperglycemic agent approved by regulatory authorities. The median HbA1c with the standard strategy was 7.5%; the intensive strategy achieved a median HbA1c of 6.4%. 2 However, the intensive strategy was stopped after a median follow-up of 3.4 years, 60% of that planned, because of 22% higher all-cause mortality. 2 Participants previously using the intensive strategy were switched to the standard strategy and continued in the trial. The cardiovascular and microvascular effects after the full 5 years of follow-up will soon be reported. Meanwhile, debate continues as to why there was higher mortality with intensive treatment and the clinical implications. Several analyses of the data obtained during randomized treatment have shed light on these issues.