February 8, 2008
Warning on A1C Targets and Diabetes Death in ACCORD Trial
Analysis of:
Hault of ACCORD Study Intensive Treatment Arm | www.nhlbi.nih.gov
This analysis is solely the work of the author. It has not been edited or endorsed by GLG.
Implications: Increased death from intensive A1C lowering in diabetic subjects raises new concerns about diabetes therapy, insulin use in combination with oral agents, and clinical biomarkers of disease complications.
Analysis:
Analysis:
Early discontinuation by the ACCORD Trial study safety monitoring board revealed excess death in diabetics treated to intensive A1C goal versus standard A1C targets. This finding focuses attention on the value of A1C lowering and/or on the utility of A1C as a clinical marker of cardiovascular risk in diabetes. However, intensive A1C lowering was achieved using polypharmacy, raising questions concerning the risk of combination therapy involving insulin, rosiglitazone and additional oral agents (eg metformin, sulfonylurea). The goal is now to reconcile ACCORD with DCCT and UKPDS data supporting lower A1C target in lowering cardiovascular risk.
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