Persistent Effects of Intensive Glycemic Control on Retinopathy in Type 2 Diabetes in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Follow-On Study.
Persistent Effects of Intensive Glycemic Control on Retinopathy in Type 2 Diabetes in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Follow-On Study.
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DOI：
10.2337/dc16-0024
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发表时间：
2016-07
期刊：
影响因子：
16.2
通讯作者：
Action to Control Cardiovascular Risk in Diabetes Follow-On (ACCORDION) Eye Study Group and the Action to Control Cardiovascular Risk in Diabetes Follow-On (ACCORDION) Study Group
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文献类型：
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作者：
Action to Control Cardiovascular Risk in Diabetes Follow-On (ACCORDION) Eye Study Group and the Action to Control Cardiovascular Risk in Diabetes Follow-On (ACCORDION) Study Group
本研究调查了在控制糖尿病心血管风险行动（雅阁）眼科研究中证实的强化血糖控制和非诺贝特治疗血脂异常在减少视网膜病变进展方面的有益作用是否在临床试验后持续存在。雅阁研究（2003-2009）将2型糖尿病受试者随机分为强化治疗组或标准治疗组，以治疗糖尿病（A1 C水平<6.0% [42 mmol/mol] vs. 7.0-7.9% [53-63 mmol/mol]）、收缩压（<120 vs. 140 mmHg）和血脂异常（非诺贝特[160 mg]加辛伐他汀或安慰剂加辛伐他汀）。在雅阁试验结束后4年，在雅阁随访（ACCORDION）眼科研究（2010-2014）中对接受基线和第4年眼科检查和眼底照片的ACCORD眼科研究参与者进行了重新检查。结果测量是糖尿病视网膜病变早期治疗研究量表上的三个或更多步骤的糖尿病视网膜病变进展。糖尿病视网膜病变进展，强化血糖治疗组为5.8%，标准血糖治疗组为12.7%。（校正比值比[aOR] 0.42，95% CI 0.28-0.63，P < 0.0001），强化降压治疗组为7.5%，标准降压治疗组为6.0%在ACCORDION Eye受试者（n = 1，310）中，非诺贝特组为11.8%，安慰剂组为10.2%（aOR 1.13，95% CI 0.71-1.79，P = 0.60）。在雅阁研究结束时，尽管A1 C水平相似，但既往强化血糖控制继续减少糖尿病视网膜病变进展。这是第一项针对2型糖尿病患者的10年持续时间和心血管疾病的研究，与英国前瞻性糖尿病研究的新诊断参与者不同，以证明这种效果。然而，非诺贝特的益处并未持续。强化血压控制没有效果。
This study investigated whether the beneficial effects of intensive glycemic control and fenofibrate treatment of dyslipidemia in reducing retinopathy progression demonstrated in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Eye Study persisted beyond the clinical trial. The ACCORD Study (2003–2009) randomized participants with type 2 diabetes to intensive or standard treatment for glycemia (A1C level at <6.0% [42 mmol/mol] vs. 7.0–7.9% [53–63 mmol/mol]), systolic blood pressure (<120 vs. 140 mmHg), and dyslipidemia (fenofibrate [160 mg] plus simvastatin or placebo plus simvastatin). ACCORD Eye Study participants, who had baseline and year 4 eye examinations and fundus photographs, were reexamined in the ACCORD Follow-On (ACCORDION) Eye Study (2010–2014) 4 years after the ACCORD trial closeout. The outcome measure was diabetic retinopathy progression of three or more steps on the Early Treatment Diabetic Retinopathy Study scale. Diabetic retinopathy progressed in 5.8% with intensive glycemic treatment versus 12.7% with standard (adjusted odds ratio [aOR] 0.42, 95% CI 0.28–0.63, P < 0.0001), 7.5% with intensive blood pressure treatment versus 6.0% for standard (aOR 1.21, 95% CI 0.61–2.40, P = 0.59), and 11.8% with fenofibrate versus 10.2% with placebo (aOR 1.13, 95% CI 0.71–1.79, P = 0.60) in ACCORDION Eye participants (n = 1,310). Prior intensive glycemic control continued to reduce diabetic retinopathy progression, despite similar A1C levels, when the ACCORD Study ended. This is the first study in people with type 2 diabetes of 10 years’ duration and established cardiovascular disease, unlike the newly diagnosed participants of the UK Prospective Diabetes Study, to demonstrate this effect. The benefit of fenofibrate, however, did not persist. Intensive blood pressure control had no effect.