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Medical News & Perspectives
March 26, 2008

Contradictory Findings Ignite Questions About Blood Glucose Targets in Diabetes

JAMA. 2008;299(12):1413-1415. doi:10.1001/jama.299.12.1413

Conflicting clinical trial findings announced through news releases and press conferences have the diabetes care community wondering about the possible dangers of aggressively lowering blood glucose below the levels recommended in current guidelines.

At issue is the February 6 announcement and statement by the National Heart, Lung, and Blood Institute (NHLBI) that it was stopping an arm of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study involving intensive treatment aimed at lowering blood glucose to reach a glycated hemoglobin A1c (HbA1c) goal of less than 6%. Current guidelines from the American Diabetes Association (ADA) set the desired HbA1c level at 7% or below. The stoppage came at the recommendation of a 10-member data and safety monitoring board that detected an unexpected higher mortality rate in patients randomized to the aggressively treated group compared with those randomized to the standard treatment group (http://www.nhlbi.nih.gov/health/prof/heart/other/accord/index.htm).