ACCORD study treatment may benefit eyes, kidneys, nerves
MedWire News: Microvascular markers of kidney, eye, and peripheral nerve function may benefit from intensive as opposed to standard treatment for hyperglycemia, show study results.
Faramarz Ismail-Beigi (Case Western Reserve University, Cleveland, Ohio, USA) and colleagues reported results on microvascular outcomes from 10,251 participants who were given intensive glucose control (n=5107; target glycated hemoglobin [HbA1c] below 6.0%) or standard treatment (n=5108; target HbA1c 7.0-7.9%) in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study.
The results were presented at the American Diabetes Association 2010 Scientific Sessions held in Orlando, Florida, USA, and simultaneously published in The Lancet journal.
The prespecified first composite outcomes evaluated were: dialysis or renal transplantation, a high serum creatinine level above 291.7 µmol/l, or retinal photocoagulation or vitrectomy; and the second composite outcome was a combination of peripheral neuropathy and the first composite outcome.
The researchers also assessed 13 secondary measures of kidney, eye, and peripheral nerve function.
Due to higher mortality in the intensive treatment group, at 3.5 years the patients on intensive therapy were given standard therapy instead for an additional 1.5 years.
At the transition, 443 and 444 of the patients in the intensive and standard treatment groups, respectively, had the first composite outcome and a corresponding 1591 and 1659 had the second composite outcome. Between-group differences for the first and second composite outcomes were not significant.
At study completion, 556 and 586 of the respective groups had the first composite outcome and 1956 and 2046 the second composite outcome, again with no significant between-group differences observed.
Although the between-group differences for the primary and secondary composite outcomes were not statistically significant, seven of the 13 secondary markers of kidney, eye, and peripheral nerve function significantly favored intensive over standard treatment. Especially notable was a delay in the onset of albuminuria and some measures of eye complications and neuropathy in intensive versus standard glucose control patients.
"Patients who develop macroalbuminuria are prone to renal failure and cardiovascular events," said Ismail-Beigi. "Less protein in the urine is a very good sign."
Other results from ACCORD were previously reported by MedWire News and showed that intensive glycemia treatment did not decrease cardiovascular risk and increased the risk for severe hypoglycemia.
"The microvascular benefits you see here in the intensive arm should be weighed against the increase in total and cardiovascular mortality, weight gain, and a higher risk for severe hypoglycemia," he concluded.
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By Helen Albert