http://www.theheart.org/web_slides/1145677.do A study on Action to Control Cardiovascular Risk in Diabetes (ACCORD Glucose) to test whether an intensive strategy that targets HbA1c levels <6.0% reduces the rate of CV events more than a standard strategy that targets an HbA1c of 7.0% to 7.9%

1. ACCORD Glucose (Action to Control
Cardiovascular Risk in Diabetes —
Glucose-lowering arm)

2. ACCORD Glucose (Action to Control Cardiovascular
Risk in Diabetes — Glucose-lowering arm)
National Heart, Lung, and Blood Institute
ACCORD telebriefing prepared remarks; February 6, 2008
• Goal:
To test whether an intensive strategy that targets HbA1c levels <6.0% reduces
the rate of CV events more than a standard strategy that targets an HbA1c of
7.0% to 7.9%
• Population and treatment:
10 000 patients with type 2 diabetes and either heart disease or two risk
factors for heart disease
Randomly assigned to intensive blood sugar lowering or to standard blood
sugar lowering
• Primary outcome:
A composite of fatal and nonfatal major CV events

3. ACCORD Glucose: Results
• The median A1c level achieved in the intensive-treatment group was 6.4%, vs
7.5% in the standard group
• The trial was stopped early because of an excess of three deaths per 1000
participants per year in the intensive group vs the standard group, over an
average of four years of treatment
Deaths in the two treatment groups at four years
Standard glycemic control Intensive glycemic control
Deaths, n 203 (11/1000/y) 257 (14/1000/y)

4. ACCORD Glucose: Commentary*
"The simple and honest answer is that we have done extensive analyses and not
identified a cause for the increased mortality."
- Dr William Friedewald
(Chair of the ACCORD steering committee)
"My key message is that the ACCORD result is not a reason to panic. The kind of
patients enrolled in this study are a minority in terms of diabetes patients, and the
treatment given was exceptionally intensive, so the average diabetic patient need not
worry about these results."
- Dr John Buse
(ACCORD steering committee member)
"This result really does defy conventional wisdom."
- Dr Steve Nissen
*All comments from The day after: Experts puzzled over increased death rate in ACCORD
(http://www.theheart.org/article/842297.do)

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