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This article has a correction

Please see: Evid Based Nurs 2009;12:38

Evid Based Nurs 12:4-6 doi:10.1136/ebn.12.1.4
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To lower or not to lower? Making sense of the latest research on intensive glycaemic control and cardiovascular outcomes

  1. Diana Sherifali1,
  2. Zubin Punthakee2
  1. 1
    School of Nursing, McMaster University, Hamilton, Ontario, Canada
  2. 2
    McMaster University Medical Centre, Hamilton, Ontario, Canada

      Diabetes is an extremely burdensome and costly chronic disease. It affects an estimated 4–6% of the world’s population, and its prevalence continues to rise.1 2 Diabetes is a major cause of blindness, end stage renal disease, and cardiovascular complications, all of which are preventable.3 4 Clinical practice guidelines for the management of diabetes emphasise the importance of optimal glycaemic control. Specifically, some clinical practice guidelines have suggested targeting a glycated haemoglobin (Hb) A1c concentration ⩽7%, or ⩽6% for those able to safely achieve it.5

      ACCORD, ADVANCE, AND UKPDS 10-YEAR FOLLOW-UP

      With the recent publication of 3 notable trials, a great deal of debate and confusion has been created about the cardiovascular effects of lowering glucose to near-normal concentrations in people with type 2 diabetes. The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, the Action in Diabetes and Vascular Disease: Preterax and Damicron Modified Release Controlled Evaluation (ADVANCE) trial, and the 10-year follow-up of the UK Prospective Diabetes Study (UKPDS) provide complementary information about cardiovascular risk reduction with glucose lowering that can be used to help patients to develop evidence-based goals of therapy individualised to their own circumstances. See abstracts in this issue on pages 12–14.

      ACCORD, ADVANCE, and the 10-year follow-up of the UKPDS all reported the effects of intensive glucose lowering on vascular outcomes.68 All 3 studies were randomised controlled trials, with an intensive glucose-lowering group and a “standard” control group with less stringent glycaemic targets. The trials differed in many respects (table 1) that may help to reconcile the differences in results (table 2).

      View this table:
      Table 1 Study and patient characteristics*
      View this table:
      Table 2 Summary of study findings*

      Participants and duration of follow-up

      There were important differences in the types of participants recruited and the duration of follow-up. ACCORD enrolled >10 000 patients starting in 2001 and followed them for a median of 3.4 years, at which point the intervention was discontinued (17 …

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