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ADA: Intensive Glucose Control May Cause Harm

In high-risk diabetics, those on intensive therapy had a 22 percent increased risk of death

MONDAY, June 9 (HealthDay News) -- In type 2 diabetics at high risk for heart attacks and strokes, intensive glucose lowering is associated with an increased risk of death over a 3.5-year period and does not significantly reduce major cardiovascular events, according to research presented this week at the American Diabetes Association's 68th Annual Scientific Sessions in San Francisco, and published in the June 12 issue of the New England Journal of Medicine.

Robert P. Byington, Ph.D., of the Wake Forest University School of Medicine in Winston-Salem, N.C., and colleagues from the ACCORD (Action to Control Cardiovascular Risk in Diabetes) study group randomly assigned 10,251 high-risk patients -- 35 percent of whom had had a previous cardiovascular event -- to receive either standard glucose therapy or intensive glucose therapy.

After one year, the researchers found that the intensive therapy group achieved lower median glycated hemoglobin levels than the standard therapy group (6.4 percent versus 7.5 percent). During follow-up, similar numbers of the intensive therapy group and standard therapy group experienced a non-fatal myocardial infarction, non-fatal stroke or death from cardiovascular causes (352 and 371, respectively). But a higher number of deaths from any cause occurred in the intensive therapy group (257 versus 203, hazard ratio 1.22), prompting discontinuation of intensive therapy after a mean of 3.5 years.

"In the ACCORD trial, patients in the intensive therapy group who did not have a history of a cardiovascular event or whose baseline glycated hemoglobin level was below 8 percent had significantly fewer fatal and non-fatal cardiovascular events than did patients at higher risk," states the author of an accompanying editorial. "These findings suggest that intensive therapy was beneficial at least in this subgroup. Whether achieving glycemic targets below 7 percent will be beneficial to the vast majority of patients with type 2 diabetes and a low risk of cardiovascular disease remains another unanswered question."

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