What are the effects of intensive glycemic control on the incidence of macrovascular events in patients with diabetes mellitus?
In the ACCORD study, patients were assigned to receive intensive therapy with a goal of normalizing the HbA1c (to ,6%) or standard therapy targeting a level of 7.0% to 7.9%. Intensive control did not significantly reduce major cardiovascular events (nonfatal MI, nonfatal stroke, and death from cardiovascular causes) but was associated with a 22% greater all-cause mortality. The VADT (Veterans Affairs Diabetes Trial) examined macrovascular complications in patients randomized to standard glycemic control or to intensive therapy (goal HbA1c of ,6%), with a planned HbA1c separation of $1.5%. There were no differences in the primary endpoint of time to occurrence of a cardiovascular event or all-cause mortality in the two groups over a median follow-up of 5.6 years.