Intensive treatment of hyperglycaemta: ACCORD

摘要

In The Lancet today, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial investigators conclude that "caution should be exercised in pursuit of a strategy of intensive glycaemic control for prevention of microvascular complications in patients with established type 2 diabetes and characteristics similar to those in the ACCORD trial. [A target of 6-0% for glycosylated haemoglobin (HbA_(lc))] or less with present strategies seems imprudent". This assessment of the study's findings is appropriate because of the adverse effects of tight glycaemic control on survival and the apparent lack of benefit on severe retinopathy. However, the conclusion is ironic in that, before the study started, a review group discussed concerns about the ethics of denying intensive glycaemic control as defined in the study to half the participants.