Press release from the ADA World's Largest Trial of Intensive Glucose Control in Type 2 Diabetes Finds http://tinyurl.com/3hw8lj or http://www.diabetes.org/for-media/pr-worlds-largest-trial-of-intensiv... SAN FRANCISO, CA (June 6, 2008)

World's Largest Trial of Intensive Glucose Control in Type 2 Diabetes Finds There is a report of a comparison discussion between ADVANCE and ACCORD here: http://news.yahoo.com/s/nm/20080606/sc_nm/diabetes_control_dc_1 Cheers, Alan, T2, Australia.

There is a report of a comparison discussion between ADVANCE and ACCORD here: http://news.yahoo.com/s/nm/20080606/sc_nm/diabetes_control_dc_1 Here are the pdfs for the lot: ACCORD Effects of Intensive Glucose Lowering in Type 2 Diabetes The Action to Control Cardiovascular Risk in Diabetes Study Group http://content.nejm.org/cgi/reprint/NEJMoa0802743v1.pdf ADVANCE Intensive Blood Glucose Control and Vascular Outcomes in Patients with Type 2 Diabetes The ADVANCE Collaborative Group* http://content.nejm.org/cgi/reprint/NEJMoa0802987v1.pdf New England Journal of Medicine Editorial Intensive Glycemic Control in the ACCORD and ADVANCE Trials http://content.nejm.org/cgi/reprint/NEJMe0804182v1.pdf New England Journal of Medicine Editorial Glycemic Targets and Cardiovascular Disease http://content.nejm.org/cgi/reprint/NEJMe0803831v1.pdf That second editorial is the better of the two in my opinion, and makes this point: In the ACCORD trial, patients in the intensive-therapy group who did not have a history of a cardiovascular event or whose _base_line glycated hemoglobin level was below 8% had significantly fewer fatal and nonfatal cardiovascular events than did patients at higher risk. These findings suggest that intensive therapy was beneficial at least in this subgroup. Whether achieving glycemic targets below 7% will be beneficial to the vast majority of patients with type 2 diabetes and a low risk of cardiovascular disease remains another unanswered question. This is a section from the first NEJM editorial, which didn't actually compare the two trials so much as attempt to make a conglomerate sense out of them. Judging by the snippet I include at the foot of one of their conclusions, I believe they failed. From the intro: Two studies in this issue of the Journal ? the ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial7 (ClinicalTrials.gov number, NCT00000620) and the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation) trial8 ? sought to determine the effect of the lowering of glucose to near-normal levels on cardiovascular risk. Although the ACCORD and ADVANCE trials both compared intensive and standard glucose-lowering targets in type 2 diabetes, the trials differed substantially (Table 1). Most patients in both studies received drugs from a variety of classes, with or without insulin. However, in the ACCORD study, there were no restrictions on glucose-lowering treatments to reach glycemic targets, whereas in the ADVANCE study, all patients in the intensive-control group were required to receive the sulfonylurea gliclazide (modified release) at initiation. Thiazolidinedione treatment was infrequent during the ADVANCE trial (<20% of participants), whereas rosiglitazone was used in 90% of the intensive-therapy group and in 58% of the standard-therapy group during the ACCORD trial. Both trials used a factorial design to test additional and different treatment interventions in their study participants: in the ACCORD study, participants were randomly assigned to undergo intensive therapy or standard therapy for the lowering of blood pressure or to receive fenofibrate or placebo; in the ADVANCE study, patients were randomly assigned to receive a combination of perindopril and indapamide or to receive placebo.9 Neither study appears to have emphasized life_style_ or dietary modification. Let me repeat that last sentence for emphasis Neither study appears to have emphasized life_style_ or dietary modification. In other words, both studies ignored that as a means of lowering A1c to their respective targets. My brief skim of both papers indicates that there were two major differences; ADVANCE covered a wider range of nationalities, and thus life_style_s, and both studies intensively used drugs, but different drugs. However, that was a very quick skim so I would be very interested in hearing opinions from others more analytical or more qualified than I. And the NEJM analysis conclusions? In part: The most appropriate target for glycated hemoglobin should remain 7%, though lower individualized targets may be appropriate when the focus is primary prevention of macrovascular disease. When glycated hemoglobin values under 7% are the goal, clinicians will need to balance the incremental benefit of a reduction in microvascular events with the increased rates of adverse events; these patients may benefit from consultation with a specialist. *sigh* Cheers, Alan, T2, Australia.

Here are the pdfs for the lot: Excellent! Thanks for doing the legwork. Nicky. T2 dx 05/04 + underactive thyroid D&E, 100ug thyroxine Last A1c 5.4%  BMI 25

Press release from the ADA World's Largest Trial of Intensive Glucose Control in Type 2 Diabetes Finds http://tinyurl.com/3hw8lj or http://www.diabetes.org/for-media/pr-worlds-largest-trial-of-intensiv e-glucose-control-in-type-2-diabetes-finds.jsp - Hide quoted text -- Show quoted text - SAN FRANCISO, CA (June 6, 2008)