ACCORD microvascular and Eye substudy: should the results change our practice?

Abstract

SUMMARY Microvascular complications of diabetes are potentially devastating and costly to both individuals and society. The United Kingdom Prospective Diabetes Study (UKPDS) and Steno-2 studies confirmed the benefits of glycemic control for reducing microvascular complications in Type 2 diabetes mellitus (T2DM) of short duration, but the benefits in people with T2DM of longer duration was not as clear. The Action to Control Cardiovascular Risk in Diabetes (ACCORD), Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) and Veterans Affairs Diabetes Trial (VADT) studies were designed to address the question of macrovascular risk reduction in people with a longer duration of T2DM, but also looked at microvascular complications. Although the microvascular primary composite outcomes were not reduced in the ACCORD trial, seven of the 13 prespecified secondary outcomes were significantly reduced, and when considering those results along with the ACCORD-Eye substudy, o...