Epidemiologic relationships between A1C and all-cause mortality during a median 3.4-year follow-up of glycemic treatment in the ACCORD trial.
Epidemiologic relationships between A1C and all-cause mortality during a median 3.4-year follow-up of glycemic treatment in the ACCORD trial.
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DOI：
10.2337/dc09-1278
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发表时间：
2010-05
期刊：
影响因子：
16.2
通讯作者：
Action to Control Cardiovascular Risk in Diabetes Investigators
中科院分区：
文献类型：
--
作者：
Riddle MC;Ambrosius WT;Brillon DJ;Buse JB;Byington RP;Cohen RM;Goff DC Jr;Malozowski S;Margolis KL;Probstfield JL;Schnall A;Seaquist ER;Action to Control Cardiovascular Risk in Diabetes Investigators
在控制糖尿病心血管风险的行动（雅阁）试验中，由于强化治疗组的死亡率意外增加，将强化血糖治疗策略与标准策略进行比较的随机治疗提前结束，作为对这一发现的潜在机制进行事后分析的一部分，我们探讨了治疗中A1 C本身是否与死亡率有独立关系。2型糖尿病患者（n = 10，251，平均年龄62岁，糖尿病中位病程10年，A1 C中位数8.1%）被随机分配到A1 C <6.0%（强化）或A1 C 7.0-7.9%（标准）的治疗策略。使用几个多变量模型分析了在停止强化治疗前3.4（中位数）年随访期间获得的数据。参与者的各种特征和基线时的研究地点与死亡风险有显著相关性。在调整这些协变量之前和之后，较高的平均治疗中A1 C是比最后一次随访间隔的A1 C或第一年A1 C降低更强的死亡率预测因子。A1 C平均值越高，死亡风险越大。强化策略的死亡风险从6- 9%A1C近似线性增加，并且仅当平均A1 C> 7%时，强化策略的死亡风险似乎高于标准策略。这些分析表明，与持续较高A1 C水平相关的因素，而不是低A1 C本身，可能是与雅阁中强化血糖治疗策略相关的死亡风险增加的原因。
Randomized treatment comparing an intensive glycemic treatment strategy with a standard strategy in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial was ended early because of an unexpected excess of mortality in the intensive arm. As part of ongoing post hoc analyses of potential mechanisms for this finding, we explored whether on-treatment A1C itself had an independent relationship with mortality. Participants with type 2 diabetes (n = 10,251 with mean age 62 years, median duration of diabetes 10 years, and median A1C 8.1%) were randomly assigned to treatment strategies targeting either A1C <6.0% (intensive) or A1C 7.0–7.9% (standard). Data obtained during 3.4 (median) years of follow-up before cessation of intensive treatment were analyzed using several multivariable models. Various characteristics of the participants and the study sites at baseline had significant associations with the risk of mortality. Before and after adjustment for these covariates, a higher average on-treatment A1C was a stronger predictor of mortality than the A1C for the last interval of follow-up or the decrease of A1C in the first year. Higher average A1C was associated with greater risk of death. The risk of death with the intensive strategy increased approximately linearly from 6–9% A1C and appeared to be greater with the intensive than with the standard strategy only when average A1C was >7%. These analyses implicate factors associated with persisting higher A1C levels, rather than low A1C per se, as likely contributors to the increased mortality risk associated with the intensive glycemic treatment strategy in ACCORD.