"Effects of intensive glucose lowering in type 2
diabetes," by the ACCORD Study Group (H.C. Gerstein, et
al.), New England Journal of Medicine, 358(24): 2545-59, 12
June 2008.
[Authors' affiliations: For the Writing Group, 10 U.S. and Canadian
institutions]
Abstract: "Background: Epidemiologic studies have shown a relationship
between glycated hemoglobin levels and cardiovascular events in patients
with type 2 diabetes. We investigated whether intensive therapy to target
normal glycated hemoglobin levels would reduce cardiovascular events in
patients with type 2 diabetes who had either established cardiovascular
disease or additional cardiovascular risk factors. Methods: In this
randomized study, 10,251 patients (mean age, 62.2 years) with a median
glycated hemoglobin level of 8.1% were assigned to receive intensive
therapy (targeting a glycated hemoglobin level below 6.0%) or standard
therapy (targeting a level from 7.0 to 7.9%). Of these patients, 38% were
women, and 35% had had a previous cardiovascular event. The primary outcome
was a composite of nonfatal myocardial infarction, nonfatal stroke, or
death from cardiovascular causes. The finding of higher mortality in the
intensive-therapy group led to a discontinuation of intensive therapy after
a mean of 3.5 years of follow-up. Results: At 1 year, stable median
glycated hemoglobin levels of 6.4% and 7.5% were achieved in the
intensive-therapy group and the standard-therapy group, respectively.
During follow-up, the primary outcome occurred in 352 patients in the
intensive-therapy group, as compared with 371 in the standard-therapy group
(hazard ratio, 0.90; 95% confidence interval [CI], 0.78 to 1.04; P=0.16).
At the same time, 257 patients in the intensive-therapy group died, as
compared with 203 patients in the standard-therapy group (hazard ratio,
1.22; 95% CI, 1.01 to 1.46; P=0.04). Hypoglycemia requiring assistance and
weight gain of more than 10 kg were more frequent in the intensive-therapy
group (P<0.001). Conclusions: As compared with standard therapy, the use
of intensive therapy to target normal glycated hemoglobin levels for 3.5
years increased mortality and did not significantly reduce major
cardiovascular events. These findings identify a previously unrecognized
harm of intensive glucose lowering in high-risk patients with type 2
diabetes."
This 2008 report from the New England Journal of Medicine was
cited 77 times in current journal articles indexed by Thomson
Reuters during July-August 2009. Only one other medicine paper published in
the last two years, aside from reviews, garnered a higher citation total
during that two-month period. Prior to the most recent bimonthly count,
citations to the paper have accrued as follows:
SOURCE:
Hot Papers Database (Included with a subscription to the print
newsletter
Science Watch®, available from the
Research Services
Group of
Thomson
Reuters. Packaged on a CD that is mailed
with each Science Watch issue, the Hot Papers
Database contains data on hundreds of highly cited papers published during
the last two years. User interface permits searching by author,
organization, journal, field, and more. Total citations, as well as
citations accrued during successive bimonthly periods, can be assessed and
graphed. An updated CD containing the most recent bimonthly data is mailed
with every new issue of Science Watch, six times a
year. The CD also includes an electronic version of the Science
Watch issue in HTML format, for personal desktop
access.