Durable change in glycaemic control following intensive management of type 2 diabetes in the ACCORD clinical trial.
Durable change in glycaemic control following intensive management of type 2 diabetes in the ACCORD clinical trial.
复制标题
在 ACCORD 临床试验中，对 2 型糖尿病进行强化管理后，血糖控制发生持久变化。
DOI：
10.1007/s00125-014-3318-5
复制
发表时间：
2014
期刊：
影响因子：
8.2
通讯作者：
ACCORDGroupofInvestigators
中科院分区：
文献类型：
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作者：
Punthakee,Zubin;Miller,MichaelE;Simmons,DebraL;Riddle,MatthewC;Ismail-Beigi,Faramarz;Brillon,DavidJ;Bergenstal,RichardM;Savage,PeterJ;Hramiak,Irene;Largay,JosephF;Sood,Ajay;Gerstein,HertzelC;ACCORDGroupofInvestigators
目的/假设我们旨在确定2型糖尿病患者在有限时间的强化血糖管理后1年血糖控制的持久性。4119名ACCORD试验参与者被随机分配为HbA1c<6.0% （42 mmol/mol）的目标，持续4.0±1.2年，系统地过渡到HbA1c7.0 - 7.9% （53-63 mmol/mol）的目标，并随访1.1±0.2年。比较过渡期HbA1c<6.5% （48 mmol/mol）或≥6.5%受试者的特征。比较HbA1c<6.5%和≥6.5%患者BMI和降糖药物的变化。泊松模型用于评估转换前达到HbA1c<6.5%对HbA1c<6.5%结束的独立影响。结果转换前HbA1c<6.5%的参与者年龄较大，病程较短，与HbA1c较高的参与者相比，胰岛素用量较少，但非胰岛素降糖药用量较多。共有823名参与者最终HbA1c<6.5%，与HbA1c较高的患者相比，转换后BMI、胰岛素剂量、促分泌剂和阿卡波糖使用的降低幅度更大（p< 0.0001）。转换时HbA1c<6.5%预测最终HbA1c<6.5%（粗RR为4.9 [95% CI 4.0, 5.9]； RR为3.9 [95% CI 3.2, 4.8]，调整了人口统计学、联合干预、干预前HbA1c、BMI和降糖药物，以及转换后BMI和降糖药物的变化）。逐渐降低转化前hba1水平与维持最终hba1 <6.5%的可能性相关。随访时间与转换后HbA1c升高无关。结论/解释：对于已确诊的糖尿病患者，在放松治疗1年后，使用联合用药使hba1水平低于6.5%的有时间限制的强化血糖管理与血糖控制相关。
Aims/hypothesisWe aimed to determine the persistence of glycaemic control 1 year after a limited period of intensive glycaemic management of type 2 diabetes.Methods4119 ACCORD Trial participants randomised to target HbA1c<6.0% (42 mmol/mol) for 4.0 ± 1.2 years were systematically transitioned to target HbA1c7.0–7.9% (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%.ResultsParticipants 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 HbA1clevels were associated with a greater likelihood of maintaining a final HbA1cof <6.5%. Follow-up duration was not associated with post-transition rise in HbA1c.Conclusions/interpretationTime-limited intensive glycaemic management using a combination of agents that achieves HbA1clevels below 6.5% in established diabetes is associated with glycaemic control more than 1 year after therapy is relaxed.