Intensive Glucose Control Reduces Some Microvascular Complications — At the Cost of Increased Mortality

Intensive glucose control in high-risk diabetes offers mixed results, according to two new analyses from the ACCORD trial.


In ACCORD, patients with type 2 diabetes and elevated cardiovascular risk were randomized to intensive glucose control or standard therapy. About half were also assigned to intensive or standard blood pressure control, and the other half to combination or standard lipid therapy. Intensive glucose control was stopped early, in 2008, because of increased mortality.


Now, writing in the Lancet, ACCORD researchers report that the glucose-control groups did not differ in composite outcomes measuring kidney function, diabetic eye complications, and peripheral neuropathy. However, several components of the composite outcomes (e.g., microalbuminuria, cataract extraction) were less common with intensive glucose control.


And in the New England Journal of Medicine, ACCORD researchers observe that both intensive glucose control and combination lipid therapy reduced progression of retinopathy, while intensive BP control did not.


Despite the microvascular benefits, the Lancet authors conclude, the increased mortality makes aggressive hemoglobin targets in high-risk diabetes seem "imprudent."