Durable change in glycaemic control following intensive management of type 2 diabetes in the ACCORD clinical trial

Zubin Punthakee, Michael E. Miller, Debra L. Simmons, Matthew C. Riddle, Faramarz Ismail-Beigi, David J. Brillon, Richard M. Bergenstal, Peter J. Savage, Irene Hramiak, Joseph F. Largay, Ajay Sood, Hertzel C. Gerstein

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Aims/hypothesis We aimed to determine the persistence of glycaemic control 1 year after a limited period of intensive glycaemic management of type 2 diabetes. Methods 4119 ACCORD Trial participants randomised to target HbA1c <6.0% (42 mmol/mol) for 4.0±1.2 years were systematically transitioned to target HbA1c 7.0–7.9% (53–63 mmol/mol) and followed for an additional 1.1±0.2 years. Characteristics of participants with HbA1c <6.5% (48 mmol/mol) or ≥6.5% at transition were compared. Changes in BMI and glucose-lowering medications were compared between those ending with HbA1c <6.5% vs ≥6.5%. Poisson models were used to assess the independent effect of attaining HbA1c <6.5% before transition on ending with HbA1c <6.5%. Results Participants with pre-transition HbA1c <6.5% were older with shorter duration diabetes and took less insulin but more non-insulin glucose-lowering agents than those with higher HbA1c. A total of 823 participants achieved a final HbA1c <6.5%, and had greater post-transition reductions in BMI, insulin dose and secretagogue and acarbose use than those with higher HbA1c (p<0.0001). HbA1c <6.5% at transition predicted final HbA1c <6.5% (crude RR 4.9 [95% CI 4.0, 5.9]; RR 3.9 [95% CI 3.2, 4.8] adjusted for demographics, co-interventions, pre-intervention HbA1c, BMI and glucose-lowering medication, and post-transition change in both BMI and glucose-lowering medication). Progressively lower pre-transition HbA1c levels were associated with a greater likelihood of maintaining a final HbA1c of <6.5%. Follow-up duration was not associated with post-transition rise in HbA1c. Conclusions/interpretation Time-limited intensive glycaemic management using a combination of agents that achieves HbA1c levels below 6.5% in established diabetes is associated with glycaemic control more than 1 year after therapy is relaxed.

Original languageEnglish (US)
Pages (from-to)2030-2037
Number of pages8
JournalDiabetologia
Volume57
Issue number10
DOIs
StatePublished - Jul 2 2014
Externally publishedYes

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Type 2 Diabetes Mellitus
Clinical Trials
Glucose
Insulin
Acarbose
Demography
glycosylated pre-hemoglobin A
Therapeutics

Keywords

  • Intensive glucose lowering
  • Long-term glycaemic control
  • Post-intervention follow-up
  • Type 2 diabetes

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Punthakee, Z., Miller, M. E., Simmons, D. L., Riddle, M. C., Ismail-Beigi, F., Brillon, D. J., ... Gerstein, H. C. (2014). Durable change in glycaemic control following intensive management of type 2 diabetes in the ACCORD clinical trial. Diabetologia, 57(10), 2030-2037. https://doi.org/10.1007/s00125-014-3318-5

Durable change in glycaemic control following intensive management of type 2 diabetes in the ACCORD clinical trial. / Punthakee, Zubin; Miller, Michael E.; Simmons, Debra L.; Riddle, Matthew C.; Ismail-Beigi, Faramarz; Brillon, David J.; Bergenstal, Richard M.; Savage, Peter J.; Hramiak, Irene; Largay, Joseph F.; Sood, Ajay; Gerstein, Hertzel C.

In: Diabetologia, Vol. 57, No. 10, 02.07.2014, p. 2030-2037.

Research output: Contribution to journalArticle

Punthakee, Z, Miller, ME, Simmons, DL, Riddle, MC, Ismail-Beigi, F, Brillon, DJ, Bergenstal, RM, Savage, PJ, Hramiak, I, Largay, JF, Sood, A & Gerstein, HC 2014, 'Durable change in glycaemic control following intensive management of type 2 diabetes in the ACCORD clinical trial', Diabetologia, vol. 57, no. 10, pp. 2030-2037. https://doi.org/10.1007/s00125-014-3318-5
Punthakee Z, Miller ME, Simmons DL, Riddle MC, Ismail-Beigi F, Brillon DJ et al. Durable change in glycaemic control following intensive management of type 2 diabetes in the ACCORD clinical trial. Diabetologia. 2014 Jul 2;57(10):2030-2037. https://doi.org/10.1007/s00125-014-3318-5
Punthakee, Zubin ; Miller, Michael E. ; Simmons, Debra L. ; Riddle, Matthew C. ; Ismail-Beigi, Faramarz ; Brillon, David J. ; Bergenstal, Richard M. ; Savage, Peter J. ; Hramiak, Irene ; Largay, Joseph F. ; Sood, Ajay ; Gerstein, Hertzel C. / Durable change in glycaemic control following intensive management of type 2 diabetes in the ACCORD clinical trial. In: Diabetologia. 2014 ; Vol. 57, No. 10. pp. 2030-2037.
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abstract = "Aims/hypothesis We aimed to determine the persistence of glycaemic control 1 year after a limited period of intensive glycaemic management of type 2 diabetes. Methods 4119 ACCORD Trial participants randomised to target HbA1c <6.0{\%} (42 mmol/mol) for 4.0±1.2 years were systematically transitioned to target HbA1c 7.0–7.9{\%} (53–63 mmol/mol) and followed for an additional 1.1±0.2 years. Characteristics of participants with HbA1c <6.5{\%} (48 mmol/mol) or ≥6.5{\%} at transition were compared. Changes in BMI and glucose-lowering medications were compared between those ending with HbA1c <6.5{\%} vs ≥6.5{\%}. Poisson models were used to assess the independent effect of attaining HbA1c <6.5{\%} before transition on ending with HbA1c <6.5{\%}. Results Participants with pre-transition HbA1c <6.5{\%} were older with shorter duration diabetes and took less insulin but more non-insulin glucose-lowering agents than those with higher HbA1c. A total of 823 participants achieved a final HbA1c <6.5{\%}, and had greater post-transition reductions in BMI, insulin dose and secretagogue and acarbose use than those with higher HbA1c (p<0.0001). HbA1c <6.5{\%} at transition predicted final HbA1c <6.5{\%} (crude RR 4.9 [95{\%} CI 4.0, 5.9]; RR 3.9 [95{\%} CI 3.2, 4.8] adjusted for demographics, co-interventions, pre-intervention HbA1c, BMI and glucose-lowering medication, and post-transition change in both BMI and glucose-lowering medication). Progressively lower pre-transition HbA1c levels were associated with a greater likelihood of maintaining a final HbA1c of <6.5{\%}. Follow-up duration was not associated with post-transition rise in HbA1c. Conclusions/interpretation Time-limited intensive glycaemic management using a combination of agents that achieves HbA1c levels below 6.5{\%} in established diabetes is associated with glycaemic control more than 1 year after therapy is relaxed.",
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AU - Ismail-Beigi, Faramarz

AU - Brillon, David J.

AU - Bergenstal, Richard M.

AU - Savage, Peter J.

AU - Hramiak, Irene

AU - Largay, Joseph F.

AU - Sood, Ajay

AU - Gerstein, Hertzel C.

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N2 - Aims/hypothesis We aimed to determine the persistence of glycaemic control 1 year after a limited period of intensive glycaemic management of type 2 diabetes. Methods 4119 ACCORD Trial participants randomised to target HbA1c <6.0% (42 mmol/mol) for 4.0±1.2 years were systematically transitioned to target HbA1c 7.0–7.9% (53–63 mmol/mol) and followed for an additional 1.1±0.2 years. Characteristics of participants with HbA1c <6.5% (48 mmol/mol) or ≥6.5% at transition were compared. Changes in BMI and glucose-lowering medications were compared between those ending with HbA1c <6.5% vs ≥6.5%. Poisson models were used to assess the independent effect of attaining HbA1c <6.5% before transition on ending with HbA1c <6.5%. Results Participants with pre-transition HbA1c <6.5% were older with shorter duration diabetes and took less insulin but more non-insulin glucose-lowering agents than those with higher HbA1c. A total of 823 participants achieved a final HbA1c <6.5%, and had greater post-transition reductions in BMI, insulin dose and secretagogue and acarbose use than those with higher HbA1c (p<0.0001). HbA1c <6.5% at transition predicted final HbA1c <6.5% (crude RR 4.9 [95% CI 4.0, 5.9]; RR 3.9 [95% CI 3.2, 4.8] adjusted for demographics, co-interventions, pre-intervention HbA1c, BMI and glucose-lowering medication, and post-transition change in both BMI and glucose-lowering medication). Progressively lower pre-transition HbA1c levels were associated with a greater likelihood of maintaining a final HbA1c of <6.5%. Follow-up duration was not associated with post-transition rise in HbA1c. Conclusions/interpretation Time-limited intensive glycaemic management using a combination of agents that achieves HbA1c levels below 6.5% in established diabetes is associated with glycaemic control more than 1 year after therapy is relaxed.

AB - Aims/hypothesis We aimed to determine the persistence of glycaemic control 1 year after a limited period of intensive glycaemic management of type 2 diabetes. Methods 4119 ACCORD Trial participants randomised to target HbA1c <6.0% (42 mmol/mol) for 4.0±1.2 years were systematically transitioned to target HbA1c 7.0–7.9% (53–63 mmol/mol) and followed for an additional 1.1±0.2 years. Characteristics of participants with HbA1c <6.5% (48 mmol/mol) or ≥6.5% at transition were compared. Changes in BMI and glucose-lowering medications were compared between those ending with HbA1c <6.5% vs ≥6.5%. Poisson models were used to assess the independent effect of attaining HbA1c <6.5% before transition on ending with HbA1c <6.5%. Results Participants with pre-transition HbA1c <6.5% were older with shorter duration diabetes and took less insulin but more non-insulin glucose-lowering agents than those with higher HbA1c. A total of 823 participants achieved a final HbA1c <6.5%, and had greater post-transition reductions in BMI, insulin dose and secretagogue and acarbose use than those with higher HbA1c (p<0.0001). HbA1c <6.5% at transition predicted final HbA1c <6.5% (crude RR 4.9 [95% CI 4.0, 5.9]; RR 3.9 [95% CI 3.2, 4.8] adjusted for demographics, co-interventions, pre-intervention HbA1c, BMI and glucose-lowering medication, and post-transition change in both BMI and glucose-lowering medication). Progressively lower pre-transition HbA1c levels were associated with a greater likelihood of maintaining a final HbA1c of <6.5%. Follow-up duration was not associated with post-transition rise in HbA1c. Conclusions/interpretation Time-limited intensive glycaemic management using a combination of agents that achieves HbA1c levels below 6.5% in established diabetes is associated with glycaemic control more than 1 year after therapy is relaxed.

KW - Intensive glucose lowering

KW - Long-term glycaemic control

KW - Post-intervention follow-up

KW - Type 2 diabetes

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