Title

Factors associated with failure to achieve a glycated haemoglobin target of <8.0% in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial

Document Type

Letter to the Editor

Publication Date

1-1-2016

Journal

Diabetes, Obesity and Metabolism

Volume

18

Issue

1

DOI

10.1111/dom.12569

Keywords

Antidiabetic drug; Clinical trial; Cost-effectiveness; Diabetes complications; Insulin therapy; Type 2 diabetes

Abstract

© 2016 John Wiley & Sons Ltd. The aim of this study was to identify the clinical features of participants in the standard therapy arm of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) glycaemia trial who failed to reach the glycated haemoglobin (HbA1c) target. We analysed 4685 participants in the standard therapy arm, comparing participants who reached the HbA1c target of <8.0% with those whose HbA1c level was ≥8.0% 12months after randomization. Baseline and 12-month clinical characteristics were compared. At 12months after randomization, 3194 participants had HbA1c <8.0% and 1491 had HbA1c ≥8.0%. Black race [odds ratio (OR) 0.74, 95% confidence interval (CI) 0.61-0.89; p=0.002], severe hypoglycaemia (OR 0.57, CI 0.37-0.89; p=0.014) and insulin use (OR 0.51, CI 0.40-0.65; p<0.001) were associated with failure to reach HbA1c goal at 12months in the adjusted model. Even with free medications, free visits with clinicians and aggressive titration of medications, >30% of participants in the standard arm of the ACCORD trial had an HbA1c ≥8.0% at 1year. Participants who were black, had severe hypoglycaemia and were on insulin were more likely to have an above-target HbA1c concentration after 12months on the standard protocol.

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