January 26, 2009

The ACCORD Trial and Control of Blood Glucose Level in Type 2 Diabetes MellitusTime to Challenge Conventional Wisdom

Arch Intern Med. 2009;169(2):150-154. doi:10.1001/archinternmed.2008.518

The decision by the National Institutes of Health to discontinue the glucose-lowering portion of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial unexpectedly after 3.5 years because of an increased mortality rate in those randomized to intensive treatment of high blood glucose level led to numerous stories in the mass media noting how experts in the field were stunned by the findings.1 Yet the results of this trial were predictable. For almost 40 years, there has been evidence that intensive lowering of glucose levels in patients with type 2 diabetes mellitus (DM) can lead to significant harm and has limited benefits. This raises the question of why so many clinicians neglected the accumulating evidence of harm and thereby got the issue of treating type 2 DM so wrong. This Commentary will seek to provide some answers to that question and to provide lessons to be learned from this experience.

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