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 language | English (US) |
|---|---|
| Pages (from-to) | 2030-2037 |
| Number of pages | 8 |
| Journal | Diabetologia |
| Volume | 57 |
| Issue number | 10 |
| DOIs | |
| State | Published - Jul 2 2014 |
| Externally published | Yes |
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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
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 journal › Article
}
TY - JOUR
T1 - Durable change in glycaemic control following intensive management of type 2 diabetes in the ACCORD clinical trial
AU - Punthakee, Zubin
AU - Miller, Michael E.
AU - Simmons, Debra L.
AU - Riddle, Matthew C.
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.
PY - 2014/7/2
Y1 - 2014/7/2
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
UR - http://www.scopus.com/inward/record.url?scp=84926684348&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84926684348&partnerID=8YFLogxK
U2 - 10.1007/s00125-014-3318-5
DO - 10.1007/s00125-014-3318-5
M3 - Article
C2 - 24985147
AN - SCOPUS:84926684348
VL - 57
SP - 2030
EP - 2037
JO - Diabetologia
JF - Diabetologia
SN - 0012-186X
IS - 10
ER -