The ACCORD study: The devil is in the details

The Action to Control Cardiovascular Risks in Diabetes Study (ACCORD) was a well-designed trial of 10,251 patients with type 2 diabetes mellitus that studied the effects of tight control of blood sugar, hypertension, and lipids. Disappointingly, as compared with standard treatment, the use of intensive therapy to target normal glycosylated hemoglobin (HbA1c) levels, tight lipid control by adding fenofibrate to a statin and aggressive blood pressure treatment with a systolic blood pressure goal of 120mmHg did not significantly reduce major cardiovascular events. The authors compare these results to other studies of the same issues and speculate about reasons for the lack of benefit in ACCORD.