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

8 Scopus citations

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

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

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