RT Journal Article
SR Electronic
T1 Effect of Intensive Compared With Standard Glycemia Treatment Strategies on Mortality by Baseline Subgroup Characteristics
JF Diabetes Care
JO Diabetes Care
FD American Diabetes Association
SP 721
OP 727
DO 10.2337/dc09-1471
VO 33
IS 4
A1 Calles-Escandón, Jorge
A1 Lovato, Laura C.
A1 Simons-Morton, Denise G.
A1 Kendall, David M.
A1 Pop-Busui, Rodica
A1 Cohen, Robert M.
A1 Bonds, Denise E.
A1 Fonseca, Vivian A.
A1 Ismail-Beigi, Faramarz
A1 Banerji, Mary Ann
A1 Failor, Alan
A1 Hamilton, Bruce
YR 2010
UL http://care.diabetesjournals.org/content/33/4/721.abstract
AB OBJECTIVE To determine if baseline subgroups in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial can be identified for whom intensive compared with standard glycemia treatment had different effects on all-cause mortality. RESEARCH DESIGN AND METHODS Exploratory post hoc intention-to-treat comparisons were made between intensive and standard glycemia groups on all-cause mortality by subgroups defined by baseline characteristics. RESULTS There were few significant interactions between baseline characteristics and effects of intensive versus standard glycemia treatment on mortality: self-reported history of neuropathy (hazard ratio [HR] 1.95, 95% CI 1.41–2.69) versus no history of neuropathy (0.99, 0.79–1.26; P value for interaction 0.0008), higher A1C (A1C >8.5%: HR 1.64, 95% CI 1.22–2.22; A1C 7.5–8.4%: 1.00, 0.75–1.34; A1C <7.5%: 1.00, 0.67–1.50; P value for interaction 0.04), and aspirin use (HR 1.45, 95% CI 1.13–1.85, compared with 0.96, 0.72–1.27, in nonusers; P value for interaction 0.03). CONCLUSIONS We found a remarkable similarity of effect from intensive compared with standard glycemia treatment on mortality across most baseline subgroups. No differential effect was found in subgroups defined by variables anticipated to have an interaction: age, duration of diabetes, and previous history of cardiovascular disease. The three baseline characteristics that defined subgroups for which there was a differential effect on mortality may help identify patients with type 2 diabetes at higher risk of mortality from intensive regimens for glycemic control. Further research is warranted. © 2010 by the American Diabetes Association.