Persistent effects of intensive glycemic control on retinopathy in type 2 diabetes in the action to control cardiovascular risk in diabetes (ACCORD) follow-on study

Emily Y. Chew, James F. Lovato, Matthew D. Davis, Hertzel C. Gerstein, Ronald P. Danis, Faramarz Ismail-Beigi, Saul Genuth, Craig M. Greven, Letitia H. Perdue, William Cushman, Marshall Elam, J. Thomas Bigger, Henry N. Ginsberg, David C. Goff, Walter T. Ambrosius

Research output: Contribution to journalArticle

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Abstract

Objectives This study investigated whether the beneficial effects of intensive glycemic control and fenofibrate treatment of dyslipidemia in reducing retinopathy progression demonstrated in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Eye Study persisted beyond the clinical trial. RESEARCH DESIGN AND METHODS The ACCORD Study (2003-2009) randomized participants with type 2 diabetes to intensive or standard treatment for glycemia (A1C level at <6.0% [42 mmol/mol] vs. 7.0-7.9% [53-63 mmol/mol]), systolic blood pressure (<120 vs. 140 mmHg), and dyslipidemia (fenofibrate [160 mg] plus simvastatin or placebo plus simvastatin). ACCORD Eye Study participants, who had baseline and year 4 eye examinations and fundus photographs, were reexamined in the ACCORD Follow-On (ACCORDION) Eye Study (2010-2014) 4 years after the ACCORD trial closeout. The outcome measure was diabetic retinopathy progression of three or more steps on the Early Treatment Diabetic Retinopathy Study scale. RESULTS Diabetic retinopathy progressed in 5.8% with intensive glycemic treatment versus 12.7% with standard (adjusted odds ratio [aOR] 0.42, 95% CI 0.28-0.63, P < 0.0001), 7.5% with intensive blood pressure treatment versus 6.0% for standard (aOR 1.21, 95% CI 0.61-2.40, P = 0.59), and 11.8% with fenofibrate versus 10.2% with placebo (aOR 1.13, 95%CI 0.71-1.79, P = 0.60) in ACCORDION Eye participants (n = 1,310). CONCLUSIONS Prior intensive glycemic control continued to reduce diabetic retinopathy progression, despite similar A1C levels, when the ACCORD Study ended. This is the first study in people with type 2 diabetes of 10 years' duration and established cardiovascular disease, unlike the newly diagnosed participants of the UK Prospective Diabetes Study, to demonstrate this effect. The benefit of fenofibrate, however, did not persist. Intensive blood pressure control had no effect.

Original languageEnglish (US)
Pages (from-to)1089-1100
Number of pages12
JournalDiabetes care
Volume39
Issue number7
DOIs
StatePublished - Jul 1 2016

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Type 2 Diabetes Mellitus
Fenofibrate
Diabetic Retinopathy
Blood Pressure
Simvastatin
Odds Ratio
Dyslipidemias
Placebos
Therapeutics
Cardiovascular Diseases
Outcome Assessment (Health Care)
Clinical Trials
Prospective Studies

All Science Journal Classification (ASJC) codes

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

Cite this

Chew, E. Y., Lovato, J. F., Davis, M. D., Gerstein, H. C., Danis, R. P., Ismail-Beigi, F., ... Ambrosius, W. T. (2016). Persistent effects of intensive glycemic control on retinopathy in type 2 diabetes in the action to control cardiovascular risk in diabetes (ACCORD) follow-on study. Diabetes care, 39(7), 1089-1100. https://doi.org/10.2337/dc16-0024

Persistent effects of intensive glycemic control on retinopathy in type 2 diabetes in the action to control cardiovascular risk in diabetes (ACCORD) follow-on study. / Chew, Emily Y.; Lovato, James F.; Davis, Matthew D.; Gerstein, Hertzel C.; Danis, Ronald P.; Ismail-Beigi, Faramarz; Genuth, Saul; Greven, Craig M.; Perdue, Letitia H.; Cushman, William; Elam, Marshall; Thomas Bigger, J.; Ginsberg, Henry N.; Goff, David C.; Ambrosius, Walter T.

In: Diabetes care, Vol. 39, No. 7, 01.07.2016, p. 1089-1100.

Research output: Contribution to journalArticle

Chew, EY, Lovato, JF, Davis, MD, Gerstein, HC, Danis, RP, Ismail-Beigi, F, Genuth, S, Greven, CM, Perdue, LH, Cushman, W, Elam, M, Thomas Bigger, J, Ginsberg, HN, Goff, DC & Ambrosius, WT 2016, 'Persistent effects of intensive glycemic control on retinopathy in type 2 diabetes in the action to control cardiovascular risk in diabetes (ACCORD) follow-on study', Diabetes care, vol. 39, no. 7, pp. 1089-1100. https://doi.org/10.2337/dc16-0024
Chew, Emily Y. ; Lovato, James F. ; Davis, Matthew D. ; Gerstein, Hertzel C. ; Danis, Ronald P. ; Ismail-Beigi, Faramarz ; Genuth, Saul ; Greven, Craig M. ; Perdue, Letitia H. ; Cushman, William ; Elam, Marshall ; Thomas Bigger, J. ; Ginsberg, Henry N. ; Goff, David C. ; Ambrosius, Walter T. / Persistent effects of intensive glycemic control on retinopathy in type 2 diabetes in the action to control cardiovascular risk in diabetes (ACCORD) follow-on study. In: Diabetes care. 2016 ; Vol. 39, No. 7. pp. 1089-1100.
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abstract = "Objectives This study investigated whether the beneficial effects of intensive glycemic control and fenofibrate treatment of dyslipidemia in reducing retinopathy progression demonstrated in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Eye Study persisted beyond the clinical trial. RESEARCH DESIGN AND METHODS The ACCORD Study (2003-2009) randomized participants with type 2 diabetes to intensive or standard treatment for glycemia (A1C level at <6.0{\%} [42 mmol/mol] vs. 7.0-7.9{\%} [53-63 mmol/mol]), systolic blood pressure (<120 vs. 140 mmHg), and dyslipidemia (fenofibrate [160 mg] plus simvastatin or placebo plus simvastatin). ACCORD Eye Study participants, who had baseline and year 4 eye examinations and fundus photographs, were reexamined in the ACCORD Follow-On (ACCORDION) Eye Study (2010-2014) 4 years after the ACCORD trial closeout. The outcome measure was diabetic retinopathy progression of three or more steps on the Early Treatment Diabetic Retinopathy Study scale. RESULTS Diabetic retinopathy progressed in 5.8{\%} with intensive glycemic treatment versus 12.7{\%} with standard (adjusted odds ratio [aOR] 0.42, 95{\%} CI 0.28-0.63, P < 0.0001), 7.5{\%} with intensive blood pressure treatment versus 6.0{\%} for standard (aOR 1.21, 95{\%} CI 0.61-2.40, P = 0.59), and 11.8{\%} with fenofibrate versus 10.2{\%} with placebo (aOR 1.13, 95{\%}CI 0.71-1.79, P = 0.60) in ACCORDION Eye participants (n = 1,310). CONCLUSIONS Prior intensive glycemic control continued to reduce diabetic retinopathy progression, despite similar A1C levels, when the ACCORD Study ended. This is the first study in people with type 2 diabetes of 10 years' duration and established cardiovascular disease, unlike the newly diagnosed participants of the UK Prospective Diabetes Study, to demonstrate this effect. The benefit of fenofibrate, however, did not persist. Intensive blood pressure control had no effect.",
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AU - Chew, Emily Y.

AU - Lovato, James F.

AU - Davis, Matthew D.

AU - Gerstein, Hertzel C.

AU - Danis, Ronald P.

AU - Ismail-Beigi, Faramarz

AU - Genuth, Saul

AU - Greven, Craig M.

AU - Perdue, Letitia H.

AU - Cushman, William

AU - Elam, Marshall

AU - Thomas Bigger, J.

AU - Ginsberg, Henry N.

AU - Goff, David C.

AU - Ambrosius, Walter T.

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N2 - Objectives This study investigated whether the beneficial effects of intensive glycemic control and fenofibrate treatment of dyslipidemia in reducing retinopathy progression demonstrated in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Eye Study persisted beyond the clinical trial. RESEARCH DESIGN AND METHODS The ACCORD Study (2003-2009) randomized participants with type 2 diabetes to intensive or standard treatment for glycemia (A1C level at <6.0% [42 mmol/mol] vs. 7.0-7.9% [53-63 mmol/mol]), systolic blood pressure (<120 vs. 140 mmHg), and dyslipidemia (fenofibrate [160 mg] plus simvastatin or placebo plus simvastatin). ACCORD Eye Study participants, who had baseline and year 4 eye examinations and fundus photographs, were reexamined in the ACCORD Follow-On (ACCORDION) Eye Study (2010-2014) 4 years after the ACCORD trial closeout. The outcome measure was diabetic retinopathy progression of three or more steps on the Early Treatment Diabetic Retinopathy Study scale. RESULTS Diabetic retinopathy progressed in 5.8% with intensive glycemic treatment versus 12.7% with standard (adjusted odds ratio [aOR] 0.42, 95% CI 0.28-0.63, P < 0.0001), 7.5% with intensive blood pressure treatment versus 6.0% for standard (aOR 1.21, 95% CI 0.61-2.40, P = 0.59), and 11.8% with fenofibrate versus 10.2% with placebo (aOR 1.13, 95%CI 0.71-1.79, P = 0.60) in ACCORDION Eye participants (n = 1,310). CONCLUSIONS Prior intensive glycemic control continued to reduce diabetic retinopathy progression, despite similar A1C levels, when the ACCORD Study ended. This is the first study in people with type 2 diabetes of 10 years' duration and established cardiovascular disease, unlike the newly diagnosed participants of the UK Prospective Diabetes Study, to demonstrate this effect. The benefit of fenofibrate, however, did not persist. Intensive blood pressure control had no effect.

AB - Objectives This study investigated whether the beneficial effects of intensive glycemic control and fenofibrate treatment of dyslipidemia in reducing retinopathy progression demonstrated in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Eye Study persisted beyond the clinical trial. RESEARCH DESIGN AND METHODS The ACCORD Study (2003-2009) randomized participants with type 2 diabetes to intensive or standard treatment for glycemia (A1C level at <6.0% [42 mmol/mol] vs. 7.0-7.9% [53-63 mmol/mol]), systolic blood pressure (<120 vs. 140 mmHg), and dyslipidemia (fenofibrate [160 mg] plus simvastatin or placebo plus simvastatin). ACCORD Eye Study participants, who had baseline and year 4 eye examinations and fundus photographs, were reexamined in the ACCORD Follow-On (ACCORDION) Eye Study (2010-2014) 4 years after the ACCORD trial closeout. The outcome measure was diabetic retinopathy progression of three or more steps on the Early Treatment Diabetic Retinopathy Study scale. RESULTS Diabetic retinopathy progressed in 5.8% with intensive glycemic treatment versus 12.7% with standard (adjusted odds ratio [aOR] 0.42, 95% CI 0.28-0.63, P < 0.0001), 7.5% with intensive blood pressure treatment versus 6.0% for standard (aOR 1.21, 95% CI 0.61-2.40, P = 0.59), and 11.8% with fenofibrate versus 10.2% with placebo (aOR 1.13, 95%CI 0.71-1.79, P = 0.60) in ACCORDION Eye participants (n = 1,310). CONCLUSIONS Prior intensive glycemic control continued to reduce diabetic retinopathy progression, despite similar A1C levels, when the ACCORD Study ended. This is the first study in people with type 2 diabetes of 10 years' duration and established cardiovascular disease, unlike the newly diagnosed participants of the UK Prospective Diabetes Study, to demonstrate this effect. The benefit of fenofibrate, however, did not persist. Intensive blood pressure control had no effect.

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