Effects of randomization to intensive glucose control on adverse events, cardiovascular disease, and mortality in older versus younger adults in the ACCORD trial

Michael E. Miller, Jeff D. Williamson, Hertzel C. Gerstein, Robert P. Byington, William Cushman, Henry N. Ginsberg, Walter T. Ambrosius, Laura Lovato, William B. Applegate

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE We explore the effect of randomized treatment, comparing intensive to standard glucose-lowering strategies on major cardiovascular outcomes, death, and severe adverse events in older versus younger participants in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. RESEARCH DESIGN AND METHODS Participants with type 2 diabetes (n = 10,251) with a mean age of 62 years, a median duration of diabetes of 10 years, and amedian A1C of 8.1% (65mmol/mol) were randomized to treatment strategies targeting either A1C <6.0% (42mmol/mol) or 7.0-7.9%(53-63mmol/mol) and followed for amean of 3.7 years.Outcomeswere analyzed within subgroups defined by baseline age (<65 vs. 65 years). RESULTS Older and younger ACCORD participants achieved similar intensive-armA1C levels and between-arm A1C differences. Within the older subgroup, similar hazards of the cardiovascular primary outcome and totalmortality were observed in the two arms. While there was no intervention effect on cardiovascular mortality in the older subgroup, there was an increased risk in the intensive arm for the younger subgroup (older hazard ratio [HR] = 0.97; younger HR = 1.71; P = 0.03). Regardless of intervention arm, the older subgroup experienced higher annualized rates of severe hypoglycemia (4.45% intensive and 1.36% standard) than the younger subgroup (2.45% intensive and 0.80% standard). CONCLUSIONS Intensive glucose lowering increased the risk of cardiovascular disease and total mortality in younger participants, whereas it had a neutral effect in older participants. The intensive to standard relative risk of severe hypoglycemia was similar in both age subgroups, with higher absolute rates in older participants within both treatment arms.

Original languageEnglish (US)
Pages (from-to)634-643
Number of pages10
JournalDiabetes care
Volume37
Issue number3
DOIs
StatePublished - Mar 1 2014

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Random Allocation
Young Adult
Cardiovascular Diseases
Glucose
Mortality
Hypoglycemia
Type 2 Diabetes Mellitus
Therapeutics

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Effects of randomization to intensive glucose control on adverse events, cardiovascular disease, and mortality in older versus younger adults in the ACCORD trial. / Miller, Michael E.; Williamson, Jeff D.; Gerstein, Hertzel C.; Byington, Robert P.; Cushman, William; Ginsberg, Henry N.; Ambrosius, Walter T.; Lovato, Laura; Applegate, William B.

In: Diabetes care, Vol. 37, No. 3, 01.03.2014, p. 634-643.

Research output: Contribution to journalArticle

Miller, ME, Williamson, JD, Gerstein, HC, Byington, RP, Cushman, W, Ginsberg, HN, Ambrosius, WT, Lovato, L & Applegate, WB 2014, 'Effects of randomization to intensive glucose control on adverse events, cardiovascular disease, and mortality in older versus younger adults in the ACCORD trial', Diabetes care, vol. 37, no. 3, pp. 634-643. https://doi.org/10.2337/dc13-1545
Miller, Michael E. ; Williamson, Jeff D. ; Gerstein, Hertzel C. ; Byington, Robert P. ; Cushman, William ; Ginsberg, Henry N. ; Ambrosius, Walter T. ; Lovato, Laura ; Applegate, William B. / Effects of randomization to intensive glucose control on adverse events, cardiovascular disease, and mortality in older versus younger adults in the ACCORD trial. In: Diabetes care. 2014 ; Vol. 37, No. 3. pp. 634-643.
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abstract = "OBJECTIVE We explore the effect of randomized treatment, comparing intensive to standard glucose-lowering strategies on major cardiovascular outcomes, death, and severe adverse events in older versus younger participants in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. RESEARCH DESIGN AND METHODS Participants with type 2 diabetes (n = 10,251) with a mean age of 62 years, a median duration of diabetes of 10 years, and amedian A1C of 8.1{\%} (65mmol/mol) were randomized to treatment strategies targeting either A1C <6.0{\%} (42mmol/mol) or 7.0-7.9{\%}(53-63mmol/mol) and followed for amean of 3.7 years.Outcomeswere analyzed within subgroups defined by baseline age (<65 vs. 65 years). RESULTS Older and younger ACCORD participants achieved similar intensive-armA1C levels and between-arm A1C differences. Within the older subgroup, similar hazards of the cardiovascular primary outcome and totalmortality were observed in the two arms. While there was no intervention effect on cardiovascular mortality in the older subgroup, there was an increased risk in the intensive arm for the younger subgroup (older hazard ratio [HR] = 0.97; younger HR = 1.71; P = 0.03). Regardless of intervention arm, the older subgroup experienced higher annualized rates of severe hypoglycemia (4.45{\%} intensive and 1.36{\%} standard) than the younger subgroup (2.45{\%} intensive and 0.80{\%} standard). CONCLUSIONS Intensive glucose lowering increased the risk of cardiovascular disease and total mortality in younger participants, whereas it had a neutral effect in older participants. The intensive to standard relative risk of severe hypoglycemia was similar in both age subgroups, with higher absolute rates in older participants within both treatment arms.",
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T1 - Effects of randomization to intensive glucose control on adverse events, cardiovascular disease, and mortality in older versus younger adults in the ACCORD trial

AU - Miller, Michael E.

AU - Williamson, Jeff D.

AU - Gerstein, Hertzel C.

AU - Byington, Robert P.

AU - Cushman, William

AU - Ginsberg, Henry N.

AU - Ambrosius, Walter T.

AU - Lovato, Laura

AU - Applegate, William B.

PY - 2014/3/1

Y1 - 2014/3/1

N2 - OBJECTIVE We explore the effect of randomized treatment, comparing intensive to standard glucose-lowering strategies on major cardiovascular outcomes, death, and severe adverse events in older versus younger participants in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. RESEARCH DESIGN AND METHODS Participants with type 2 diabetes (n = 10,251) with a mean age of 62 years, a median duration of diabetes of 10 years, and amedian A1C of 8.1% (65mmol/mol) were randomized to treatment strategies targeting either A1C <6.0% (42mmol/mol) or 7.0-7.9%(53-63mmol/mol) and followed for amean of 3.7 years.Outcomeswere analyzed within subgroups defined by baseline age (<65 vs. 65 years). RESULTS Older and younger ACCORD participants achieved similar intensive-armA1C levels and between-arm A1C differences. Within the older subgroup, similar hazards of the cardiovascular primary outcome and totalmortality were observed in the two arms. While there was no intervention effect on cardiovascular mortality in the older subgroup, there was an increased risk in the intensive arm for the younger subgroup (older hazard ratio [HR] = 0.97; younger HR = 1.71; P = 0.03). Regardless of intervention arm, the older subgroup experienced higher annualized rates of severe hypoglycemia (4.45% intensive and 1.36% standard) than the younger subgroup (2.45% intensive and 0.80% standard). CONCLUSIONS Intensive glucose lowering increased the risk of cardiovascular disease and total mortality in younger participants, whereas it had a neutral effect in older participants. The intensive to standard relative risk of severe hypoglycemia was similar in both age subgroups, with higher absolute rates in older participants within both treatment arms.

AB - OBJECTIVE We explore the effect of randomized treatment, comparing intensive to standard glucose-lowering strategies on major cardiovascular outcomes, death, and severe adverse events in older versus younger participants in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. RESEARCH DESIGN AND METHODS Participants with type 2 diabetes (n = 10,251) with a mean age of 62 years, a median duration of diabetes of 10 years, and amedian A1C of 8.1% (65mmol/mol) were randomized to treatment strategies targeting either A1C <6.0% (42mmol/mol) or 7.0-7.9%(53-63mmol/mol) and followed for amean of 3.7 years.Outcomeswere analyzed within subgroups defined by baseline age (<65 vs. 65 years). RESULTS Older and younger ACCORD participants achieved similar intensive-armA1C levels and between-arm A1C differences. Within the older subgroup, similar hazards of the cardiovascular primary outcome and totalmortality were observed in the two arms. While there was no intervention effect on cardiovascular mortality in the older subgroup, there was an increased risk in the intensive arm for the younger subgroup (older hazard ratio [HR] = 0.97; younger HR = 1.71; P = 0.03). Regardless of intervention arm, the older subgroup experienced higher annualized rates of severe hypoglycemia (4.45% intensive and 1.36% standard) than the younger subgroup (2.45% intensive and 0.80% standard). CONCLUSIONS Intensive glucose lowering increased the risk of cardiovascular disease and total mortality in younger participants, whereas it had a neutral effect in older participants. The intensive to standard relative risk of severe hypoglycemia was similar in both age subgroups, with higher absolute rates in older participants within both treatment arms.

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