When the facts change, I change my mind. What do you do, sir? - John Maynard Keynes
Wow! I'm going to go out on a limb here but I believe that ACCORD (
Action to Control Cardiovascular Risk in Diabetes) is going to be this decade's WHI (Women's Health Initiative). If you'll recall, back in 2002, WHI turned on its head the then prevailing wisdom with regards to estrogen replacement therapy. Since ACCORD was initially published back in 2008 (I guess I can't read a calendar), it's done the same with regards to tight control of cardiovascular risk factors in diabetics. Intensive control of
blood pressure,
cholesterol and even
glucose didn't positively impact mortality and other clinical outcomes. If anything, tight glucose control actually increased mortality in the population studied (older patients w/long standing diabetes).
The latest salvo was
published online yesterday in Lancet Neurology concluding that intensive glucose lowering did not improve cognitive outcomes (although it did positively impact total brain volume). In the MIND (Memory in Diabetes) subset of ACCORD, the authors followed 2,977 participants who'd already been randomized to various treatment protocols as per ACCORD. After 40 months, there was no difference in cognitive function between intensive glucose control vs standard measures. Sure it's nice to have a bigger brain, but it's the function of the mass that matters.
Worse yet, as noted in previous analyses, total mortality was increased in the intensively treated group. No benefit. Greater risk. Looks like we
need to individualize our treatment goals rather than use the same cookie cutter to drive everyone down towards a hemoglobin A1c <6.
The Times They Are a-Changin' - Bob Dylan
No comments:
Post a Comment