Effects of intensive glycemic control on microvascular outcomes in type 2 diabetes mellitus are modified by long-term HbA1c variability: A post hoc analysis of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial
Authors' conclusion
The effects of intensive glycemic control on microvascular outcomes in T2DM appear to be modified by the variability of HbA1c during the treatment process, suggesting the significance of dynamic monitoring of HbA1c levels and timely adjustments to the therapeutic strategy among individuals with a high HbA1c variability.
Study context
- Population
- Participants with T2D in ACCORD with ≥3 HbA1c measurements before new-onset microvascular outcomes; HbA1c variability = coefficient of variation (CV) of HbA1c from enrollment to transition from intensive to standard therapy
- Comparison
- Intensive vs standard glycaemic control, by quartile of long-term HbA1c variability (CV)
- Primary endpoint
- New-onset microvascular outcomes: nephropathy, retinopathy and neuropathy
Primary result
As reported in the abstract
Retinopathy, intensive vs standard, by quartile of HbA1c variability
Intensive treatment vs Standard treatmentHazard ratio (95 % CI)
Lowest quartile of HbA1c-CV
0.65(0.56–0.75)
Second quartile of HbA1c-CV
0.84(0.71–0.98)
Third quartile of HbA1c-CV
0.97(0.82–1.14)
Highest quartile of HbA1c-CV
1.28(1.08–1.53)
- Intensive therapy reduced all microvascular outcomes with lower HbA1c-CV but increased risk with highest HbA1c-CV
- all P values for interaction < 0.0001
Further findings
Median, %
| Outcome | Intensive treatment | Standard treatment |
|---|---|---|
| HbA1c CV | 9.79 (IQR 7.32 %-13.35 %) | 7.91 (IQR 5.66 %-10.76 %) |
Microvascular cases recorded · median 22,005, 23,121 and 13,080 person-years of follow-up, respectively
- Nephropathy cases
- 2,905
- Retinopathy cases
- 2,655
- Neuropathy cases
- 1,974
HbA1c-CV quartile and microvascular risk within groups
- Standard treatment: lower HbA1c-CV (Q1 vs Q2) associated with higher risk of all microvascular outcomes; higher HbA1c-CV (Q4) with higher risk of nephropathy only
- Intensive treatment: only higher HbA1c-CV associated with higher risk of microvascular outcomes
Original publication
Effects of intensive glycemic control on microvascular outcomes in type 2 diabetes mellitus are modified by long-term HbA1c variability: A post hoc analysis of the ACCORD trial. Diabetes Res Clin Pract. Published 20 January 2024. doi:10.
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