Intensive glycaemic control does not seem to reduce all cause mortality in patients with type 2 diabetes .
OBJECTIVE To assess the effect of targeting intensive glycaemic control versus conventional glycaemic control on  all cause mortality and cardiovascular mortality , non-fatal myocardial infa rct ion , microvascular complications , and severe hypoglycaemia in patients with type 2 diabetes .
Effect of intensive treatment of hyperglycaemia on microvascular outcomes in type 2 diabetes: an analysis of the ACCORD randomised trial
BACKGROUND Hyperglycaemia is associated with increased risk of cardiovascular complications in people with type 2 diabetes . We investigated whether reduction of blood glucose concentration decreases the rate of microvascular complications in people with type 2 diabetes . METHODS ACCORD was a parallel-group , r and omised trial done in 77 clinical sites in North America . People with diabetes , high HbA(1c ) concentrations ( > 7.5 % ) , and cardiovascular disease ( or > or=2 cardiovascular risk factors ) were r and omly assigned by central r and omisation to intensive ( target haemoglobin A(1c ) [ HbA(1c ) ] of < 6.0 % ) or st and ard ( 7.0 - 7.9 % ) glycaemic therapy . In this analysis , the prespecified composite outcomes were : dialysis or renal transplantation , high serum creatinine ( > 291.7 micromol/L ) , or retinal photocoagulation or vitrectomy ( first composite outcome ) ; or peripheral neuropathy plus the first composite outcome ( second composite outcome ) . 13 prespecified secondary measures of kidney , eye , and peripheral nerve function were also assessed . Investigators and participants were aware of treatment group assignment . Analysis was done for all patients who were assessed for microvascular outcomes , on the basis of treatment assignment , irrespective of treatments received or compliance to therapies . ACCORD is registered with Clinical Trials.gov , number NCT00000620 . FINDINGS 10 251 patients were r and omly assigned , 5128 to the intensive glycaemia control group and 5123 to st  and ard group . Intensive therapy was stopped before study end because of higher mortality in that group , and patients were transitioned to st and ard therapy . At transition , the first composite outcome was recorded in 443 of 5107 patients in the intensive group versus 444 of 5108 in the st and ard group ( HR 1.00 , 95 % CI 0.88 - 1.14 ; p=1.00 ) , and the second composite outcome was noted in 1591 of 5107 versus 1659 of 5108 ( 0.96 , 0.89 - 1.02 ; p=0.19 ) . Results were similar at study end ( first composite outcome 556 of 5119 vs 586 of 5115 [ HR 0.95 , 95 % CI 0.85 - 1.07 , p=0.42 ] ; and second 1956 of 5119 vs 2046 of 5115 , respectively [ 0.95 , 0.89 - 1.01 , p=0.12 ] ) . Intensive therapy did not reduce the risk of advanced measures of microvascular outcomes , but delayed the onset of albuminuria and some measures of eye complications and neuropathy . Seven secondary measures at study end favoured intensive therapy ( p<0.05 ) . INTERPRETATION Microvascular benefits of intensive therapy should be weighed against the increase in total and cardiovascular disease-related mortality , increased weight gain , and high risk for severe hypoglycaemia . FUNDING US National Institutes of Health ; National Heart , Lung , and Blood Institute ; National Institute of Diabetes and Digestive and Kidney Diseases ; National Institute on Aging ; National Eye Institute ; Centers for Disease Control and Prevention ; and General Clinical Research Centers
Intensive glycaemic control does not seem to reduce all cause mortality in patients with type 2 diabetes .
OBJECTIVE To assess the effect of targeting intensive glycaemic control versus conventional glycaemic control on  all cause mortality and cardiovascular mortality , non-fatal myocardial infa rct ion , microvascular complications , and severe hypoglycaemia in patients with type 2 diabetes .