The design of the accord trial and the effect of intensive versus standard glucoselowering. Action to control cardiovascular risk in diabetes accord. A retrospective cohort study analyzed data from the kaiser permanente northwest database of 8231 patients with diabetes, none of whom had hf at baseline, and 8845 matched subjects without diabetes. The action to control cardiovascular risk in diabetes study accord presentation transcript. The members of the action to control cardiovascular risk in diabetes accord study group are listed in section 1 in supplementary appendix 1, available with the full text of this article at nejm. Prospective study of type 2 diabetes and cognitive decline in women aged 7081 years logroscino et al. Routine visits were to occur at 2, 4, 8, and 16 weeks following randomization, then every four months for the rest of the study, for all participants. The accord action to control cardiovascular risk in diabetes. Over the past 20 years, during which increasing attention in the field of type 2 diabetes mellitus t2dm has focused on atherosclerotic complications, heart failure hf has emerged as another serious complication occurring significantly more frequently in people with t2dm. Diabetes accounts for 30% to 50% of the incident cases of endstage kidney disease in the united states. As in previous years, this summit served as a reference meeting for indepth discussions on the topic of recently completed and presented cvots. The action to control cardiovascular disease in diabetes accord study has completed its full 5yr planned followup, and all main results have been published 14.
Edic epidemiology of diabetes interventions and complications is a multicenter, longitudinal, observational study focusing on nephropathy and macrovascular complications of type 1 diabetes patients. What does the news about the accord study mean to you. They also experience increased rates of nonfatal myocardial infarction and stroke. You are free to use the slides in presentations without further permission as long as the slide content is not altered in any way and appropriate attribution is made to the american diabetes association the association name and logo on the slides constitutes appropriate attribution. Diabetic dyslipidemia, which has also been called atherogenic dyslipidemia a term that describes the lipid abnormalities in people with. Persistent effects of intensive glycemic control on retinopathy in type 2 diabetes in the action to control cardiovascular risk in diabetes accord followon study. The uploader spent hisher valuable time to create this diabetes mellitus powerpoint presentation slides, to share hisher useful content with the world. Apr 22, 2011 the accord lipid trial used fenofibrate because 1 data from the fenofibrate intervention and event lowering in diabetes field trial indicated that the risk of myositis when fenofibrate was combined with a statin was negligible. And even though the accord blood pressure study was done in patients with diabetes, on average, they were probably a little lowerrisk than our sprint participants because of their somewhat.
Effects of intensive bloodpressure control in type 2. However, insights from new clinical research along with patient education provide new edges to improve cardiovascular outcomes in your diabetes patients. Jul 27, 2012 accord lipid action to control cardiovascular risk indiabeteslipidlowering armh ginsberg columbia university, new york, nyamerican college of cardiology 2010 scientific sessions goal. Presentation of this example does not carry with it the authors. The edic study consists of 28 clinics throughout the united states and canada.
Accord which stands for action to control cardiovascular risk in diabetes involved type 2. Women with type 2 diabetes performed worse on all cognitive tests than women without diabetes at baseline odds ratios 1. Clinical implications of the accord trial the journal of. The accord lipid trial used fenofibrate because 1 data from the fenofibrate intervention and event lowering in diabetes field trial indicated that the risk of myositis when fenofibrate was combined with a statin was negligible.
We do have previous data with fibrates in diabetics or tghdl axis disorders. Conclusions prior intensive glycemic control continued to reduce diabetic retinopathy progression, despite similar a1c levels, when the accord study ended. Francesco cosentino, cardiology unit, department of medicine solna, karolinska institute and karolinska university hospital, solna, 171 76 stockholm, sweden. Clinical implications of the accord trial the journal of clinical. Nov 26, 2017 a large clinical study designed to determine whether intensively lowering blood glucose levels, intensively lowering blood pressure, or treating blood lipid levels could reduce the risk of heart attack, stroke, or death in people with type 2 diabetes. The overall goal of the accord trial is to determine whether cvd event rates can be reduced in patients with type 2 diabetes.
Risk in diabetes accord trial was designed, the study questions focused on the. Accord is one of the largest studies ever conducted in adults with type 2 diabetes who were at especially high risk of cardiovascular events, such as heart attacks, stroke, or death from cardiovascular disease. Preterax and diamicron mr controlled evaluation, and vadt veterans affairs diabetes trial resulted in a1c values of. It is therefore now appropriate to take stock and consider the clinical implications of these results. Action to control cardiovascular risk in diabetes accord accord the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. This is the first study in people with type 2 diabetes of 10 years duration and established cardiovascular disease, unlike the newly diagnosed participants of the uk prospective diabetes study, to demonstrate this effect. We assessed 10 251 adults aged 4079 years with established type 2 diabetes, mean glycated haemoglobin a 1c hba 1c concentration of 67 mmolmol 83%, and risk factors for ischaemic heart disease enrolled in the accord trial. Kdoqi clinical practice guideline for diabetes and ckd. Accord action to control cardiovascular risk in diabetes advance. In brief management of individuals with type 2 diabetes involves complex decisionmaking to attain good glycemic control. The dais diabetes atherosclerosis intervention study investigators data a very successful angiographic. Effects of intensive glycaemic control on ischaemic heart. Nejm 2010 on face value the trial seems to be null on the ability of fenofibrate to improve outcomes in t2dm patients.
Accord which stands for action to control cardiovascular risk in diabetes involved type 2 diabetics at high risk for heart problems. Jensen june 12, 2008 accord diabetes trial1 intensive versus standard a1c targets in t2dm mortality with a very intensive glucose lowering strategy in high cv risk t2dm patients research question. The action to control cardiovascular risk in diabetes accord study similarly showed that more intensive control, achieving an hba 1c of 6. Accord diabetes trial intensive versus standard a1c targets. Type 2 diabetes is a strong risk factor for cardiovascular outcomes, and the incidence of these outcomes. This randomized control trial rct sets out to test if there is a correlation between a1c and. Accord diabetes trial intensive versus standard a1c. Action to control cardiovascular risk in diabetes accord trial. This year, focus was placed on the cvots carmelina, declaretimi 58 and.
Accord action to control cardiovascular risk in diabetes. The accord study is a federally funded clinical study designed to figure out whether extremely tight blood glucose control reduces heart attacks and other cardiac problems in diabetics. Listing a study does not mean it has been evaluated by the u. A personalized approach to the care of these individuals provides a unique management plan for each patient. Recruitment strategies in the action to control cardiovascular risk. The 10,251 participants had a median diabetes duration of 10 yr and mean age of. Effects of intensive glucose lowering in type 2 diabetes nejm. The origin trial outcome reduction with initial glargine. Participants were assigned to intensive or standard therapy target hba 1c less than 42 or 5363 mmolmol less than 60% or 7079%, respectively. Effects of intensive glucose lowering in type 2 diabetes. Diabetes mellitus 101 for cardiologists, part 14 other sets in this series. Diabetes powerpoint presentation free download as powerpoint presentation. To test whether the treatment of blood lipids with a fibrate plus a statin can reduce the risk of major cvd events in patients with type 2 diabetes who. Diabetes asia 3 our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease.
Hazard ratios 95% cis relating the risk of death to the updated annualized number of hypoglycemic episodes and the updated annualized number of intervals with unrecognized hypoglycemia were obtained using cox proportional hazards regression models. Research design and methods the accord study 20032009 randomized participants with. The types of diabetes there are two types of diabetes one is type 1 diabetes the other is type 2 diabetes 3. In this weeks homerun slides, we focus in on the specifics of the drug, ranolazine, which is used to treat angina, and its effects on patients with diabetes to download these slides in powerpoint. Report from the 4th cardiovascular outcome trial cvot. Advance collaborative group, patel a, macmahon s, et al. The study of more than 10,000 participants is sponsored by the national institutes of health.
Fenofibrate therapy and cardiovascular risk in statintreated. Design of the cooperative study on glycemic control and complications in diabetes mellitus type 2. The accord trial was a large north american trial of intense versus standard glucoselowering therapy in people with established type 2 diabetes and additional risk factors for cardiovascular disease. The accord study was based on the hypothesis that a 1.
Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. In 2008, the results of the glucose control study raised some eyebrows. Free download diabetes mellitus powerpoint presentation slides. The origin study was conducted by the population health research institute in hamilton, ontario canada, working in conjunction with the sponsor, and an independent steering committee. A large clinical study designed to determine whether intensively lowering blood glucose levels, intensively lowering blood pressure, or treating blood lipid levels could reduce the risk of heart attack, stroke, or death in people with type 2 diabetes. Accord was a parallelgroup, randomised trial done in 77 clinical sites in north america. The accord action to control cardiovascular risk in.
This is really an amazing life saving book, its a blessing beyond words. Heart failure considerations of antihyperglycemic medications. The accord study data and biospecimens are now available in the nhlbi biological specimen and data repository information coordinating center biolincc overview of accord and accordion. In the case of fenofibrate, 2 cardiovascular end point trials conducted within the last decade failed to show benefit with administration of fenofibrate in patients with type 2 diabetes either alone in the field study 24 or as addon therapy to statin in the accord study. The accord study was a maximum effort to determine whether treating. Landmark accord trial finds intensive blood pressure and. People with diabetes, high hba 1c concentrations 75%, and cardiovascular disease or. Three trials accord action to control cardiovascular risk in diabetes, advance action in diabetes and vascular disease. Accord diabetes trial intensive versus standard a1c targets in. Although this represents a significant public health concern, it is important to note that only 30% to 40% of patients with diabetes develop. The action to control cardiovascular risk in diabetes accord trial is a.
Mortality with a very intensive glucose lowering strategy in. Atherosclerotic cardiovascular disease is increased severalfold in most patients with type 2 diabetes, particularly patients who are older and have other risk factors 1,2. This is really an amazing lifesaving book, its a blessing beyond words. Accord glucose action to controlcardiovascular risk in diabetes. Download figure open in new tab download powerpoint. Diabetes is a chronic lifelong disease marked by high levels of sugar in the blood. From 2002 to march 2017, the world diabetes foundation provided usd million in funding to 511 projects in 115 countries. Diabetic kidney disease and diabetic nephropathy are the leading cause of endstage kidney disease in the united states and most developed countries. Conclusions in the accord bp trial, compared with combined standard.