Trial reportDiabetes care2010
Epidemiologic relationships between A1C and all-cause mortality during a median 3.4-year follow-up of glycemic treatment in the ACCORD trial.
Trial report in Diabetes care, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 161 papers, 15 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
161 citing papers in PubMed, 15 syntheses or guidelines pooled it.
- American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update.Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2022Guideline
- Association of magnesium intake with type 2 diabetes and total stroke: an updated systematic review and meta-analysis.BMJ open · 2020Pooled it
- Treatment of Diabetes in Older Adults: An Endocrine Society* Clinical Practice Guideline.The Journal of clinical endocrinology and metabolism · 2019Guideline
- Insulin and glucose-lowering agents for treating people with diabetes and chronic kidney disease.The Cochrane database of systematic reviews · 2018Pooled it
- Glucose targets for preventing diabetic kidney disease and its progression.The Cochrane database of systematic reviews · 2017Pooled it
- Behaviour change techniques targeting both diet and physical activity in type 2 diabetes: A systematic review and meta-analysis.The international journal of behavioral nutrition and physical activity · 2017Pooled it
- Effect of ethnicity on HbA1c levels in individuals without diabetes: Systematic review and meta-analysis.PloS one · 2017Pooled it
- Cardiovascular Safety of Incretin-Based Therapies in Type 2 Diabetes: Systematic Review of Integrated Analyses and Randomized Controlled Trials.Advances in therapy · 2017Pooled it
- Cardiac implications of hypoglycaemia in patients with diabetes - a systematic review.Cardiovascular diabetology · 2013Pooled it
- Glycemic control and cardiovascular disease: what's a doctor to do?Current diabetes reports · 2012Pooled it
- Standards of medical care in diabetes--2012.Diabetes care · 2012Guideline
- Bariatric surgery: an IDF statement for obese Type 2 diabetes.Diabetic medicine : a journal of the British Diabetic Association · 2011 · on this mapGuideline
- Cardiovascular safety of exenatide BID: an integrated analysis from controlled clinical trials in participants with type 2 diabetes.Cardiovascular diabetology · 2011Pooled it
- Strategies for optimizing glycemic control and cardiovascular prognosis in patients with type 2 diabetes mellitus.Mayo Clinic proceedings · 2011Pooled it
- Standards of medical care in diabetes--2011.Diabetes care · 2011Guideline
- A Randomized Controlled Trial Testing the Effects of a Social Needs Navigation Intervention on Health Outcomes and Healthcare Utilization among Medicaid Members with Type 2 Diabetes.International journal of environmental research and public health · 2024Trial
- 5-Year simulation of diabetes-related complications in people treated with tirzepatide or semaglutide versus insulin glargine.Diabetes, obesity & metabolism · 2024 · on this mapTrial
- Clinical associations of an updated medication effect score for measuring diabetes treatment intensity.Chronic illness · 2021Trial
- A Type 2 Diabetes Subtype Responsive to ACCORD Intensive Glycemia Treatment.Diabetes care · 2021Trial
- Possible differential benefits of edetate disodium in post-myocardial infarction patients with diabetes treated with different hypoglycemic strategies in the Trial to Assess Chelation Therapy (TACT).Journal of diabetes and its complications · 2020Trial
101 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
13 authors.
Funding
Abstract
objectiveRandomized treatment comparing an intensive glycemic treatment strategy with a standard strategy in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial was ended early because of an unexpected excess of mortality in the intensive arm. As part of ongoing post hoc analyses of potential mechanisms for this finding, we explored whether on-treatment A1C itself had an independent relationship with mortality. RESEARCH DESIGN AND
methodsParticipants with type 2 diabetes (n = 10,251 with mean age 62 years, median duration of diabetes 10 years, and median A1C 8.1%) were randomly assigned to treatment strategies targeting either A1C <6.0% (intensive) or A1C 7.0-7.9% (standard). Data obtained during 3.4 (median) years of follow-up before cessation of intensive treatment were analyzed using several multivariable models.
resultsVarious characteristics of the participants and the study sites at baseline had significant associations with the risk of mortality. Before and after adjustment for these covariates, a higher average on-treatment A1C was a stronger predictor of mortality than the A1C for the last interval of follow-up or the decrease of A1C in the first year. Higher average A1C was associated with greater risk of death. The risk of death with the intensive strategy increased approximately linearly from 6-9% A1C and appeared to be greater with the intensive than with the standard strategy only when average A1C was >7%.
conclusionsThese analyses implicate factors associated with persisting higher A1C levels, rather than low A1C per se, as likely contributors to the increased mortality risk associated with the intensive glycemic treatment strategy in ACCORD.
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What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.