Intensive glucose control and recurrent cardiovascular events: 14-year follow-up investigation of the ACCORDION study.
cardiovascular diseases
diabetes mellitus
randomized controlled trial
type 2 diabetes
Journal
Diabetes/metabolism research and reviews
ISSN: 1520-7560
Titre abrégé: Diabetes Metab Res Rev
Pays: England
ID NLM: 100883450
Informations de publication
Date de publication:
Jul 2023
Jul 2023
Historique:
revised:
20
08
2022
received:
21
04
2022
accepted:
26
02
2023
medline:
10
7
2023
pubmed:
12
3
2023
entrez:
11
3
2023
Statut:
ppublish
Résumé
While cardiovascular disease in patients with type 2 diabetes commonly progresses with the occurrence of repeated events, most trials consider the effect of glucose-lowering strategies only on the first event. We examined the Action to Control Cardiovascular Risk in Diabetes trial and its observational follow-up study (ACCORDION) to investigate the effect of intensive glucose control on multiple events and further identify any subgroup effects. A recurrent events analysis, using a negative binomial regression model, was applied to estimate the treatment effect on different consecutive cardiovascular disease events, including non-fatal myocardial infarction, non-fatal stroke, hospitalisation from heart failure, and cardiovascular death. Interaction terms were used to identify potential effect modifiers. The robustness of the results was confirmed in sensitivity analyses using alternative models. The median duration of follow-up was 7.7 years. Of the 5128 participants in the intensive and 5123 in the standard glucose control arm, respectively, 822 (16.0%) and 840 (16.4%) participants experienced a single event; 189 (3.7%) and 214 (4.2%) participants experienced two events; 52 (1.0%) and 40 (0.8%) experienced three events; and 1 (0.02%) and 1 (0.02%) experienced four events. There was no evidence of a treatment effect, with a rate difference of 0.0 (-0.3, 0.3) per 100 person-years comparing intensive versus standard intervention, although with non-significantly lower event rates in younger patients with HbA1c < 7% and higher event rates in older patients with HbA1c ≥ 9%. Intensive glucose control may not affect cardiovascular disease progression except in select subgroups. Since time-to-first event analysis may miss beneficial or harmful effects of glucose control on the risk of cardiovascular disease, recurrent events analysis should be routinely analysed in cardiovascular outcome trials, particularly when investigating long-term treatment effects. NCT00000620, clinicaltrials.gov.
Substances chimiques
Hypoglycemic Agents
0
Blood Glucose
0
Glycated Hemoglobin
0
Banques de données
ClinicalTrials.gov
['NCT00000620']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e3634Subventions
Organisme : University of Leicester
Informations de copyright
© 2023 The Authors. Diabetes/Metabolism Research and Reviews published by John Wiley & Sons Ltd.
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