临床时讯 ＞ 临床研究
Diabetes Care. 2010 Jan 26. [Epub ahead of print]
Effect of intensive compared with standard glycemia treatment strategies on mortality by baseline subgroup characteristics: The ACCORD trial.
Calles-Escandón J, Lovato LC, Simons-Morton DG, Kendall DM, Pop-Busui R, Cohen RM, Bonds DE, Fonseca V, Ismail-Beigi F, Banerji MA, Failor A, Hamilton B.
1 Wake Forest University Health Sciences, Department of Internal Medicine, Winston-Salem, NC.
Objective: To determine if baseline subgroups in the ACCORD trial can be identified for whom intensive compared with standard glycemia treatment had different effects on all-cause mortality. Research Design and Methods: Exploratory post-hoc intention-to-treat comparisons between intensive and standard glycemia groups on all-cause mortality by subgroups defined by baseline characteristics. Results: There were few significant interactions between baseline characteristics and effects of intensive vs standard glycemia treatment on mortality: self-reported history of neuropathy (HR=1.95, 95% CI 1.41-2.69 versus no history of neuropathy (HR 0.99, 95% CI 0.79 - 1.26; p-value for interaction 0.0008), higher A1c (A1c > 8.5%: HR=1.64, 95% CI 1.22-2.22; A1c 7.5-8.4%, HR=1.00, 95% CI 0.75-1.34; A1c < 7.5%: HR=1.00, 95% CI 0.67-1.50; p-value for interaction 0.04), and aspirin use (HR = 1.45, 95% CI: 1.13-1.85, compared to HR=0.96 (0.72-1.27) in non-users; p-value for interaction 0.03). Conclusions: We found a remarkable similarity of effect from intensive compared with standard glycemia treatment on mortality across most baseline subgroups. No differential effect was found in subgroups defined by variables anticipated to have an interaction: age, duration of diabetes, previous history of cardiovascular disease. The 3 baseline characteristics that defined subgroups for which there was a differential effect on mortality may help identify patients with type 2 diabetes at higher risk of mortality from very intensive regimens for glycemia control. Further research is warranted.