Diabetes Dateline
Spring/Summer 2008

ACCORD Trial Continues After Strategy Change

Study to End in 2009

Although the intensive blood glucose—also called blood sugar—lowering treatment part of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study was discontinued earlier this year, the examination of treatments to control blood pressure and lipids will continue until the study’s originally planned end in June 2009.

ACCORD was designed to test three treatment approaches for decreasing the high rate of cardiovascular disease among adults with type 2 diabetes who are at especially high risk for heart attacks and strokes. These approaches included

• intensive lowering of blood glucose levels to near normal compared with standard blood glucose treatment
• intensive lowering of blood pressure compared with standard blood pressure treatment
• treatment of blood lipids by a fibrate and statin, rather than a statin alone

At the recommendation of an independent, expert advisory board, the National Heart, Lung, and Blood Institute (NHLBI), the major sponsor of ACCORD, halted the blood glucose treatment part of the study when data showed that intensively reducing blood glucose below current clinical guidelines to near normal levels increased death rates in these high-risk individuals with type 2 diabetes. Study participants who were receiving intensive blood glucose lowering treatment now receive the less intensive standard treatment.

“The ACCORD results can now be considered when doctors are tailoring blood sugar strategies for adults with type 2 diabetes who are at especially high risk for cardiovascular disease,” said Denise G. Simons-Morton, M.D., Ph.D., NHLBI project officer for ACCORD.

Findings Instructive

“So far, findings from ACCORD have been instructive, and we look forward to data from the blood pressure and lipid components of the trial,” said Judith Fradkin, M.D., director of the Division of Diabetes, Endocrinology, and Metabolic Diseases at the National Institute of Diabetes and Digestive and Kidney Diseases, which provides the study with funding and scientific expertise.

However, she cautioned that “the results should not be extrapolated beyond the high-risk population studied” and noted that “few patients will need changes in their therapy based on these results because current guidelines do not aim for near normal levels of blood glucose and this intensive control is rarely achieved with current medical care in comparable patients.”

Diabetes is an increasingly important cause of cardiovascular disease in the United States. About 65 percent of people with diabetes die from heart disease or stroke. The National Diabetes Information Clearinghouse has a booklet entitled Prevent diabetes problems: Keep your heart and blood vessels healthy and a fact sheet entitled Diabetes, Heart Disease, and Stroke. Copies of these publications are available at www.diabetes.niddk.nih.gov/dm/pubs/complications_heart and www.diabetes.niddk.nih.gov/dm/pubs/stroke, respectively.

In addition, the National Diabetes Education Program has a fact sheet entitled Be Smart About Your Heart: Control the ABCs of Diabetes, which is available at www.ndep.nih.gov/diabetes/pubs/BeSmart_Article.pdf. For more information about ACCORD, go to www.accordtrial.org.

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NIH Publication No. 08–4562
August 2008