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Comparison of the three trials of intensive glycemic control and CVD outcomes

Comparison of the three trials of intensive glycemic control and CVD outcomes
  ACCORD ADVANCE VADT
Participant characteristics
n 10,251 11,140 1791
Mean age (years) 62 66 60
Duration of diabetes (years) 10 8 11.5
History of CVD (%) 35 32 40
Median baseline A1C (%) 8.1 7.2 9.4
On insulin at baseline (%) 35 1.5 52
Protocol characteristics
A1C goals (%; I versus S)* <6.0 versus 7.0-7.9 ≤6.5 versus "based on local guidelines" <6.0 (action if >6.5) versus planned separation of 1.5
Protocol for glycemic control
(I versus S)*
Multiple drugs in both arms Multiple drugs added to gliclizide versus multiple drugs with no gliclizide Multiple drugs in both arms
Management of other risk factors Embedded blood pressure and lipid trials Embedded blood pressure trial Protocol for intensive treatment in both arms
On-study characteristics
Achieved median A1C (%; I versus S) 6.4 versus 7.5 6.3 versus 7.0 6.9 versus 8.5
On insulin at study end (%)
(I versus S)*
77 versus 55* 40 versus 24 89 versus 74
Weight changes (kg)
Intensive glycemic control arm +3.5 –0.1 +7.8
Standard glycemic control arm +0.4 –1.0 +3.4
Severe hypoglycemia (participants with one or more episodes during study; %)
  • Intensive glycemic control arm
16.2 2.7 21.2
  • Standard glycemic control arm
5.1 1.5 9.9
Outcomes
Definition of primary outcome Nonfatal MI, nonfatal stroke, CVD death Microvascular plus macrovascular (nonfatal MI, nonfatal stroke, CVD death) outcomes Nonfatal MI, nonfatal stroke, CVD death, hospitalization for heart failure, revascularization
HR for primary outcome (95% CI) 0.90 (0.78-1.04) 0.9 (0.82-0.98); macrovascular 0.94 (0.84-1.06) 0.88 (0.74-1.05)
HR for mortality findings (95% CI) 1.22 (1.01-1.46) 0.93 (0.83-1.06) 1.07 (0.81-1.42)
CVD: cardiovascular disease; ACCORD: Action to Control Cardiovascular Risk in Diabetes; ADVANCE: Action in Diabetes and Vascular Disease; VADT: Veterans Affairs Diabetes Trial; A1C: glycated hemoglobin; I: intensive glycemic control; S: standard glycemic control; MI: myocardial infarction; HR: hazard ratio.
* Insulin rates for ACCORD are for any use during the study.
From: American Diabetes Association. Standards of Medical Care in Diabetes – 2010. Diabetes Care 2010; 33:S11. Copyright and all rights reserved. Material from this publication has been used with the permission of American Diabetes Association.
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