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Review
. 2015:126:62-76.

Glycemic Targets in Diabetes Care: Emerging Clarity after Accord

John B Buse  1
Affiliations
Review

Glycemic Targets in Diabetes Care: Emerging Clarity after Accord

John B Buse. Trans Am Clin Climatol Assoc. 2015.

Abstract

Through the 1990s convincing evidence emerged from studies involving relatively recent onset diabetes that glycemic control achieving glycated hemoglobin A1c levels of approximately 7% was associated with improved microvascular outcomes. Based on advocacy groups' statements encouraging lower targets and recognition of cardiovascular disease as the leading cause of death in diabetes, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study was funded in 1999 to explore more intensive targets and techniques in the treatment of type 2 diabetes. Most surprisingly, intensive management targeting normal levels of glycemia was associated with increased mortality and the ACCORD trial was terminated early in 2008. Post hoc analyses have allowed the emergence of some clarity around the role of glycemic management and targets in diabetes care and are the subject of this review.

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Conflict of interest statement

Potential Conflicts of Interest: John Buse is an investigator and/or consultant without any direct financial benefit under contracts between his employer and the following companies: Amylin, Andromeda, Astellas, AstraZeneca, Boehringer-Ingelheim, Bristol-Myers Squibb, Dance Pharmaceuticals, Elcylex, Eli Lilly, GI Dynamics, GlaxoSmithKline, Halozyme, Hoffman-LaRoche, Intarcia Therapeutics, Johnson & Johnson, Lexicon, LipoScience, MacroGencis, Medtronic MiniMed, Merck, Metabolic Solutions Development Company, Metabolon, Metavention, Novartis, Novo Nordisk, Orexigen, Osiris, Pfizer, Quest, Rhythm, Sanofi, Scion NeuroStim, Takeda, Tolerex, Transtech Pharma, Veritas, and Verva. He has received direct payments and stock options from PhaseBio.

References

    1. Sacks DB. Measurement of hemoglobin A1c: a new twist on the path to harmony. Diabetes Care. 2012;35:2674–80. - PMC - PubMed
    1. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–86. - PubMed
    1. Effect of intensive diabetes management on macrovascular events and risk factors in the Diabetes Control and Complications Trial. Am J Cardiol. 1995;75:894–903. - PubMed
    1. Nathan DM, Cleary PA, Backlund JY, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005;353:2643–53. - PMC - PubMed
    1. Writing Group for the DCCT/EDIC Research Group. Association between 7 years of intensive treatment of type 1 diabetes and long-term mortality. JAMA. 2015;313:45–53. - PMC - PubMed

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