Presentation of this example does not carry with it the authors. Landmark accord trial finds intensive blood pressure and. Effects of intensive glucose lowering in type 2 diabetes nejm. Persistent effects of intensive glycemic control on retinopathy in type 2 diabetes in the action to control cardiovascular risk in diabetes accord followon study. We do have previous data with fibrates in diabetics or tghdl axis disorders. In 2008, the results of the glucose control study raised some eyebrows. The types of diabetes there are two types of diabetes one is type 1 diabetes the other is type 2 diabetes 3. And even though the accord blood pressure study was done in patients with diabetes, on average, they were probably a little lowerrisk than our sprint participants because of their somewhat. Diabetes is a chronic lifelong disease marked by high levels of sugar in the blood.
In brief management of individuals with type 2 diabetes involves complex decisionmaking to attain good glycemic control. Francesco cosentino, cardiology unit, department of medicine solna, karolinska institute and karolinska university hospital, solna, 171 76 stockholm, sweden. The study of more than 10,000 participants is sponsored by the national institutes of health. Diabetes accounts for 30% to 50% of the incident cases of endstage kidney disease in the united states. Edic epidemiology of diabetes interventions and complications is a multicenter, longitudinal, observational study focusing on nephropathy and macrovascular complications of type 1 diabetes patients. Design of the cooperative study on glycemic control and complications in diabetes mellitus type 2. The accord trial was a large north american trial of intense versus standard glucoselowering therapy in people with established type 2 diabetes and additional risk factors for cardiovascular disease. A retrospective cohort study analyzed data from the kaiser permanente northwest database of 8231 patients with diabetes, none of whom had hf at baseline, and 8845 matched subjects without diabetes. Mortality with a very intensive glucose lowering strategy in. To test whether the treatment of blood lipids with a fibrate plus a statin can reduce the risk of major cvd events in patients with type 2 diabetes who. This year, focus was placed on the cvots carmelina, declaretimi 58 and.
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 origin study was conducted by the population health research institute in hamilton, ontario canada, working in conjunction with the sponsor, and an independent steering committee. These associated risk factors include hypertension, obesity, and dyslipidemia. Report from the 4th cardiovascular outcome trial cvot. Type 2 diabetes is a strong risk factor for cardiovascular outcomes, and the incidence of these outcomes. Research design and methods the accord study 20032009 randomized participants with. Accord glucose action to controlcardiovascular risk in diabetes. Download figure open in new tab download powerpoint. Listing a study does not mean it has been evaluated by the u.
The overall goal of the accord trial is to determine whether cvd event rates can be reduced in patients with type 2 diabetes. The accord study was based on the hypothesis that a 1. Accord diabetes trial intensive versus standard a1c. The design of the accord trial and the effect of intensive versus standard glucoselowering. Diabetic dyslipidemia, which has also been called atherogenic dyslipidemia a term that describes the lipid abnormalities in people with. The accord study is a federally funded clinical study designed to figure out whether extremely tight blood glucose control reduces heart attacks and other cardiac problems in diabetics. Participants were assigned to intensive or standard therapy target hba 1c less than 42 or 5363 mmolmol less than 60% or 7079%, respectively. A personalized approach to the care of these individuals provides a unique management plan for each patient. Free download diabetes mellitus powerpoint presentation slides. Over the past 20 years, during which increasing attention in the field of type 2 diabetes mellitus t2dm has focused on atherosclerotic complications, heart failure hf has emerged as another serious complication occurring significantly more frequently in people with t2dm.
Accord which stands for action to control cardiovascular risk in diabetes involved type 2 diabetics at high risk for heart problems. They also experience increased rates of nonfatal myocardial infarction and stroke. The accord action to control cardiovascular risk in. The edic study consists of 28 clinics throughout the united states and canada.
This is really an amazing life saving book, its a blessing beyond words. Accord was a parallelgroup, randomised trial done in 77 clinical sites in north america. Conclusions in the accord bp trial, compared with combined standard. Action to control cardiovascular risk in diabetes accord accord the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. A large clinical study designed to determine whether intensively lowering blood glucose levels, intensively lowering blood pressure, or treating blood lipid levels could reduce the risk of heart attack, stroke, or death in people with type 2 diabetes. Jensen june 12, 2008 accord diabetes trial1 intensive versus standard a1c targets in t2dm mortality with a very intensive glucose lowering strategy in high cv risk t2dm patients research question. The action to control cardiovascular risk in diabetes accord study similarly showed that more intensive control, achieving an hba 1c of 6. Accord diabetes trial intensive versus standard a1c targets. Although this represents a significant public health concern, it is important to note that only 30% to 40% of patients with diabetes develop. Nejm 2010 on face value the trial seems to be null on the ability of fenofibrate to improve outcomes in t2dm patients. Accord action to control cardiovascular risk in diabetes advance. In the case of fenofibrate, 2 cardiovascular end point trials conducted within the last decade failed to show benefit with administration of fenofibrate in patients with type 2 diabetes either alone in the field study 24 or as addon therapy to statin in the accord study. The action to control cardiovascular disease in diabetes accord study has completed its full 5yr planned followup, and all main results have been published 14. Apr 22, 2011 the accord lipid trial used fenofibrate because 1 data from the fenofibrate intervention and event lowering in diabetes field trial indicated that the risk of myositis when fenofibrate was combined with a statin was negligible.
Accord which stands for action to control cardiovascular risk in diabetes involved type 2. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. People with diabetes, high hba 1c concentrations 75%, and cardiovascular disease or. The accord study was a maximum effort to determine whether treating. Accord study group and accord eye study group, effects of medical therapies on retinopathy progression in type 2 diabetes. Accord is one of the largest studies ever conducted in adults with type 2 diabetes who were at especially high risk of cardiovascular events, such as heart attacks, stroke, or death from cardiovascular disease. The accord study data and biospecimens are now available in the nhlbi biological specimen and data repository information coordinating center biolincc overview of accord and accordion. Fenofibrate therapy and cardiovascular risk in statintreated. In advanceon, intensive glucose lowering did not confer a lasting benefit for reduction in stroke, mi, or death, but an intensive bloodpressurelowering regimen did have persistent effects. The 10,251 participants had a median diabetes duration of 10 yr and mean age of. Clinical implications of the accord trial the journal of. Preterax and diamicron mr controlled evaluation, and vadt veterans affairs diabetes trial resulted in a1c values of. Diabetes is an inflammatory, cardiometabolic disease. Three trials accord action to control cardiovascular risk in diabetes, advance action in diabetes and vascular disease.
Effects of intensive bloodpressure control in type 2. Effects of intensive glucose lowering in type 2 diabetes. From 2002 to march 2017, the world diabetes foundation provided usd million in funding to 511 projects in 115 countries. The origin trial outcome reduction with initial glargine. The accord action to control cardiovascular risk in diabetes.
Prospective study of type 2 diabetes and cognitive decline in women aged 7081 years logroscino et al. Advance collaborative group, patel a, macmahon s, et al. We assessed 10 251 adults aged 4079 years with established type 2 diabetes, mean glycated haemoglobin a 1c hba 1c concentration of 67 mmolmol 83%, and risk factors for ischaemic heart disease enrolled in the accord trial. Action to control cardiovascular risk in diabetes accord trial.
Nov 26, 2017 a large clinical study designed to determine whether intensively lowering blood glucose levels, intensively lowering blood pressure, or treating blood lipid levels could reduce the risk of heart attack, stroke, or death in people with type 2 diabetes. It is therefore now appropriate to take stock and consider the clinical implications of these results. This is really an amazing lifesaving book, its a blessing beyond words. The dais diabetes atherosclerosis intervention study investigators data a very successful angiographic.
The members of the action to control cardiovascular risk in diabetes accord study group are listed in section 1 in supplementary appendix 1, available with the full text of this article at nejm. This randomized control trial rct sets out to test if there is a correlation between a1c and. Diabetes asia 3 our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. Diabetes mellitus 101 for cardiologists, part 14 other sets in this series. The action to control cardiovascular risk in diabetes accord trial is a. However, insights from new clinical research along with patient education provide new edges to improve cardiovascular outcomes in your diabetes patients. Routine visits were to occur at 2, 4, 8, and 16 weeks following randomization, then every four months for the rest of the study, for all participants. Hazard ratios 95% cis relating the risk of death to the updated annualized number of hypoglycemic episodes and the updated annualized number of intervals with unrecognized hypoglycemia were obtained using cox proportional hazards regression models. Jul 27, 2012 accord lipid action to control cardiovascular risk indiabeteslipidlowering armh ginsberg columbia university, new york, nyamerican college of cardiology 2010 scientific sessions goal. You are free to use the slides in presentations without further permission as long as the slide content is not altered in any way and appropriate attribution is made to the american diabetes association the association name and logo on the slides constitutes appropriate attribution. In this weeks homerun slides, we focus in on the specifics of the drug, ranolazine, which is used to treat angina, and its effects on patients with diabetes to download these slides in powerpoint. Clinical implications of the accord trial the journal of clinical.
As in previous years, this summit served as a reference meeting for indepth discussions on the topic of recently completed and presented cvots. Accord action to control cardiovascular risk in diabetes. Summary of accord, advance, and vadt trials powerpoint ppt presentation. Diabetes powerpoint presentation free download as powerpoint presentation. Effects of intensive glycaemic control on ischaemic heart. What does the news about the accord study mean to you. Accord diabetes trial intensive versus standard a1c targets in. Risk in diabetes accord trial was designed, the study questions focused on the. The accord lipid trial used fenofibrate because 1 data from the fenofibrate intervention and event lowering in diabetes field trial indicated that the risk of myositis when fenofibrate was combined with a statin was negligible. Recruitment strategies in the action to control cardiovascular risk. The action to control cardiovascular risk in diabetes study accord presentation transcript. The uploader spent hisher valuable time to create this diabetes mellitus powerpoint presentation slides, to share hisher useful content with the world.
Women with type 2 diabetes performed worse on all cognitive tests than women without diabetes at baseline odds ratios 1. Action to control cardiovascular risk in diabetes accord. Kdoqi clinical practice guideline for diabetes and ckd. 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. Conclusions prior intensive glycemic control continued to reduce diabetic retinopathy progression, despite similar a1c levels, when the accord study ended. Heart failure considerations of antihyperglycemic medications. Diabetic kidney disease and diabetic nephropathy are the leading cause of endstage kidney disease in the united states and most developed countries.
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