Durable change in glycaemic control following intensive management of type 2 diabetes in the ACCORD clinical trial
Autor: | David J. Brillon, Debra L. Simmons, Zubin Punthakee, Hertzel C. Gerstein, Joseph Largay, Richard M. Bergenstal, Irene Hramiak, Ajay Sood, Peter J. Savage, Michael E. Miller, Faramarz Ismail-Beigi, Matthew C. Riddle |
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Rok vydání: | 2014 |
Předmět: |
Adult
Blood Glucose Male medicine.medical_specialty Endocrinology Diabetes and Metabolism Treatment outcome 030209 endocrinology & metabolism Type 2 diabetes 030204 cardiovascular system & hematology Article law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Diabetes mellitus Internal Medicine medicine Humans Hypoglycemic Agents Intensive care medicine Aged Glycated Hemoglobin business.industry Extramural Human physiology Middle Aged medicine.disease 3. Good health Surgery Clinical trial Treatment Outcome Diabetes Mellitus Type 2 Female business Intensive management |
Zdroj: | Diabetologia. 57(10) |
ISSN: | 1432-0428 |
Popis: | We aimed to determine the persistence of glycaemic control 1 year after a limited period of intensive glycaemic management of type 2 diabetes.4119 ACCORD Trial participants randomised to target HbA1c6.0% (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 HbA1c6.5% (48 mmol/mol) or ≥6.5% at transition were compared. Changes in BMI and glucose-lowering medications were compared between those ending with HbA1c6.5% vs ≥6.5%. Poisson models were used to assess the independent effect of attaining HbA1c6.5% before transition on ending with HbA1c6.5%.Participants with pre-transition HbA1c6.5% 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 HbA1c6.5%, and had greater post-transition reductions in BMI, insulin dose and secretagogue and acarbose use than those with higher HbA1c (p0.0001). HbA1c6.5% at transition predicted final HbA1c6.5% (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 of6.5%. Follow-up duration was not associated with post-transition rise in HbA1c.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. |
Databáze: | OpenAIRE |
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