ADA: Intensive Therapy Helps in Some Diabetes Outcomes

But ACCORD analysis shows that benefits need to be weighed against risk of serious adverse events
By Rick Ansorge
HealthDay Reporter

TUESDAY, June 29 (HealthDay News) -- In patients with established type 2 diabetes, intensive glucose-lowering therapy improves some outcomes but is also associated with increased mortality, weight gain, and an increased risk of severe hypoglycemia, according to a study published online June 29 in The Lancet to coincide with presentation at the American Diabetes Association's 70th Scientific Sessions, held from June 25 to 29 in Orlando, Fla.

Faramarz Ismail-Beigi, M.D., of the Case Western Reserve University in Cleveland, and colleagues conducted an analysis of the ACCORD study, in which the first composite outcome was dialysis or renal transplantation, high serum creatinine, or retinal photocoagulation or vitrectomy, and the second composite outcome was peripheral neuropathy plus the first composite outcome. They found that intensive therapy did not reduce risk of advanced measures of microvascular outcomes; however, it did delay the onset of albuminuria, improve some measures of eye complications and neuropathy, and was associated with improvements in seven secondary measures. They also found that intensive therapy was associated with increased weight gain and high risk for severe hypoglycemia.

In a related study published online June 29 in the New England Journal of Medicine, researchers from the ACCORD Study Group and the ACCORD Eye Study Group found that, in type 2 diabetes patients, intensive glycemic control and combination dyslipidemia treatment -- though not intensive control of blood pressure -- lower the rate of diabetic retinopathy progression.

"The observed benefits associated with intensive glycemia management should be weighed against higher total and cardiovascular-related mortality, weight gain, and severe hypoglycemia in patients at high risk of cardiovascular disease," Ismail-Beigi and colleagues conclude.

Several researchers in both studies disclosed financial relationships with pharmaceutical and medical device companies, several of which donated study medications, equipment, or supplies for the second study.

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