2008 Action to Control Cardiovascular Risk in Diabetes (ACCORD)

Question 1

ACCORD Clinical Question?

Answer 1

In patients with T2DM, does intensive glycemic control targeting a HbA1c <6% versus standard glycemic control targeting a HbA1c 7-7.9% reduce the risk of CV events?

Question 2

ACCORD bottom line

Answer 2

In patients with T2DM, intensive glycemic control (target HbA1c <6%) increases mortality compared to standard control (target A1c 7-7.9%).

Question 3

Why was ACCORD stopped early?

Answer 3

intensive glycemic control was associated with increased all-cause (1.41% vs. 1.14%; P=0.04; NNH 370) and CV mortality (0.79% vs. 0.56%; P=0.02).

Question 4

ACCORD design and n

Answer 4

Multicenter, double-blinded, two-by-two factorial, randomized controlled trial, 10,251, 2X2 bc statin added to some groups

Question 5

ACCORD primary outcome

Answer 5

Annual rate of nonfatal MI or nonfatal stroke or CV death

Question 6

ACCORD inclusion criteria

Answer 6

• Type 2 diabetes mellitus
• Hemoglobin A1c ≥7.5%
• Age 40-79 years with CAD or 55-79 years with
• Anatomical evidence of significant atherosclerosis
• Albuminuria
• LVH
• ≥2 cardiovascular risk factors (dyslipidemia, HTN, current smoking, obesity)

Question 7

In ACCORD patient’s were randomized by ___, ___, and strict or lenient glycemic control

Answer 7

• 46% randomized to intensive (SBP <120) vs. standard (SBP <140) blood pressure therapy
• 54% randomized to fenofibrate vs. placebo; all received statin to achieve good LDL control

Question 8

ACCORD criticisms

Answer 8

1. Increased mortality could have been due to rosiglitazone (91% vs 57% use) or other specific agents or polypharmacy in the intensive group
2. Disproportionate weight gain between the groups may have influenced the outcome
3. No report of blood pressure medications used specifically ACE-inhibitors and ARBs, which confer greater benefit for diabetics than other agents
4. Fewer patients in the intensive treatment arm received ACE-inhibitors (69.7% vs 71.9%)