Diabetes Self-Management Blog

By now, you have probably heard of the Action to Control Cardiovascular Risk in Diabetes, or ACCORD, trial. (If not, you can check out “The ACCORD Trial Findings: What You Should Know” for a full report.)

This study, which was initiated in 1999, involves people who have Type 2 diabetes and a history of or high risk of cardiovascular disease. There were originally three branches of the trial, concentrating on blood glucose control, blood pressure control, and cholesterol and triglyceride control, respectively. The branch that focused on blood glucose control sought to compare an intensive treatment group (in which people aimed to achieve an HbA1c level below 6.0%) to a standard treatment group (in which people aimed for an HbA1c level from 7.0% to 7.9%) to determine which strategy more effectively reduced the rate of cardiovascular events. However, due to concerns about an unexpected, slightly increased rate of death among those who were tightly controlling their blood glucose, the intensive treatment arm of the trial was halted 18 months earlier than scheduled.

Not surprisingly, this outcome has led to a lot of discussion in the diabetes blogging community. Several bloggers took issue with the manner in which many mainstream media outlets presented the information, noting that the data do not apply to a large number of people with diabetes. For example, as Bernard Farrell at Bernard’s Diabetes Blog points out, the findings of the ACCORD trial don’t pertain to people with Type 1 diabetes. And as Amy Tenderich at Diabetes Mine notes, the results also don’t apply to many with Type 2 diabetes, such as younger people who are not at high risk of heart disease. Over at Scott’s Web Log, diabetes blogger Scott Strumello expresses hope that this situation will call attention to what he views as a “fixation on glycemic control above all else [that] has been detrimental to patient health.”

The American Diabetes Association also weighed in on the matter, advising people who have diabetes and cardiovascular disease or multiple risk factors for cardiovascular disease to consult with their health-care team about their treatment goals.

For more information about the ACCORD trial, visit the study’s official Web site or the “Questions and Answers” page of the National Heart, Lung, and Blood Institute, the sponsor of the trial.

This blog entry was written by Assistant Editor Diane Fennell.

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Comments
  1. From everything I’ve seen about ACCORD, the culprit wasn’t the tight control, it was all the drugs they threw at people to try to achieve control. Some people were on Avandia, Byetta, Actos, and several others. They weren’t trying to bring their blood glucose down with self-management.

    Now they are reporting this as if tight control is the problem and even advising people to seek tight control of cholesterol and blood pressure (through drugs, of course!) instead. This will make things even worse.

    The whole study is a complete refutation of the American obsession with treating numbers instead of patients, with relying on drugs exclusively, and with not supporting self-management. Type 2 diabetes is an environmental illness. We need to change the sick environment and the way we respond to (live in) it. People need help to change behaviors and resist the environment. Drugs can often make things worse—as the ACCORD results testify.

    Posted by David Spero RN |
  2. It would be good if one of our professional blogers could interview Dr. Herschel Gerstein at McMaster University in Hamilton, Ontario at some point in the future when all this settles down. The Good Dr. is part of the Accord, Origin and Advantage studies so he probably would be the best person to put all of this in the proper perspective. Telling patients to speak to their GP is not helpful since they may know even less about diabetes than the patient.

    Posted by CalgaryDiabetic |

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