ACCORD.

By now, most of my readers know about ACCORD, a type 2 diabetes study on the effect of intensive blood glucose control (under 6.0% A1C) on cardiovascular disease that was partially stopped this week. 257 deaths occurred for the intensive treatment group, while 203 deaths occurred in the standard treatment group (aiming for A1C between 7.0 and 7.9%).

Things to remember:

1. The deaths occurred in people with two or more existing cardiovascular risk factors OTHER THAN type 2 diabetes (hypertension, high cholesterol, among others).

2. I know some members of our type 1 community have been told that their newly discovered non-proliferative retinopathy may have been a result of a sudden change towards tighter control. Remember, retinopathy involves blood vessels, too. Perhaps sudden tight control in people with other cardiovascular risks isn’t the best idea if it leads to strange happenings with blood vessels. (Irl Hirsch, MD has even suggested this.)

3. For all we know, participants who died may have done so as a result of intensive exercise.

I think the information in this halted study could be useful in determining individualized A1C goals based on other cardiovascular risks. Only more information concerning the study participants who died will tell.

What I do want to know:

• How many participants who died had previous heart disease (treatment for narrowed arteries, prior heart attack, prior stroke, etc) or had a strong family history of heart disease?
• What medication combinations were they taking? After all the scares over Avandia, Actos, and Zetia, you have to wonder. For that matter, what kind of exercise were these people doing?
• How many of these events were related to severe hypoglycemia, despite the press release saying otherwise?