Trial reportDiabetes care2016
Persistent Effects of Intensive Glycemic Control on Retinopathy in Type 2 Diabetes in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Follow-On Study.
Trial report in Diabetes care, 2016. The graph read 3 numbers from its abstract, feeding 2 cells of the map: it favours the comparator in 1, finds no clear difference in 1. Cited by 75 papers, 8 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.
RESULTS: Diabetic retinopathy progressed in 5.8% with intensive glycemic treatment versus 12.7% with standard (adjusted odds ratio [aOR] 0.42, 95% CI 0.28-0.63, P < 0.0001), 7.5% with intensive blood pressure treatment versus 6.0% for standard (aOR 1.21, 95% CI 0.61-2.40, P = 0.59), and 11.8% with fenofibrate versus 10.2% with placebo (aOR 1.13, 95% CI 0.71-1.79, P = 0.60) in ACCORDION Eye participants (n = 1,310).
RESULTS: Diabetic retinopathy progressed in 5.8% with intensive glycemic treatment versus 12.7% with standard (adjusted odds ratio [aOR] 0.42, 95% CI 0.28-0.63, P < 0.0001), 7.5% with intensive blood pressure treatment versus 6.0% for standard (aOR 1.21, 95% CI 0.61-2.40, P = 0.59), and 11.8% with fenofibrate versus 10.2% with placebo (aOR 1.13, 95% CI 0.71-1.79, P = 0.60) in ACCORDION Eye participants (n = 1,310).
RESULTS: Diabetic retinopathy progressed in 5.8% with intensive glycemic treatment versus 12.7% with standard (adjusted odds ratio [aOR] 0.42, 95% CI 0.28-0.63, P < 0.0001), 7.5% with intensive blood pressure treatment versus 6.0% for standard (aOR 1.21, 95% CI 0.61-2.40, P = 0.59), and 11.8% with fenofibrate versus 10.2% with placebo (aOR 1.13, 95% CI 0.71-1.79, P = 0.60) in ACCORDION Eye participants (n = 1,310).
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Where it lands on the map
Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.
What it adds to each cell
For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.
Other lipid agents×blood pressure
InconclusiveOpen on the map →What to test next →1 readable study in this cell: 0 favour the treatment, 1 find no difference, 0 favour the comparator.
Other lipid agents×adverse events & safety
ContradictsOpen on the map →What to test next →4 readable studies in this cell: 3 favour the treatment, 1 find no difference, 0 favour the comparator.
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
75 citing papers in PubMed, 8 syntheses or guidelines pooled it, 177 citations in OpenAlex.
- The Prevalence and Progression of Microvascular Complications and the Interaction With Ethnicity and Socioeconomic Status in People With Type 2 Diabetes: A Systematic Review and Meta-Analysis.Journal of diabetes research · 2025Pooled it
- Fenofibrate for diabetic retinopathy.The Cochrane database of systematic reviews · 2023Pooled it
- Blood pressure control for diabetic retinopathy.The Cochrane database of systematic reviews · 2023Pooled it
- 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
- Correlation between the progression of diabetic retinopathy and inflammasome biomarkers in vitreous and serum - a systematic review.BMC ophthalmology · 2022Pooled it
- Treatment of Diabetes in Older Adults: An Endocrine Society* Clinical Practice Guideline.The Journal of clinical endocrinology and metabolism · 2019Guideline
- Clinical significance of 'cardiometabolic memory': a systematic review of randomized controlled trials.Hypertension research : official journal of the Japanese Society of Hypertension · 2017Pooled it
- Intensive Blood Pressure Strategy on Cardiovascular Diseases in Patients With Metabolic Syndrome: Post Hoc Analysis of a Clinical Trial.Journal of the American Heart Association · 2025Trial
- Fasting Glucose of 6.1 mmol/L as a Possible Optimal Target for Type 2 Diabetic Patients with Insulin Glargine: A Randomized Clinical Trial.Journal of diabetes research · 2021Trial
- Semaglutide, reduction in glycated haemoglobin and the risk of diabetic retinopathy.Diabetes, obesity & metabolism · 2018 · on this mapTrial
- ACCORDION MIND: results of the observational extension of the ACCORD MIND randomised trial.Diabetologia · 2017Trial
- Retinal Outcomes in Diabetes: Antihyperglycemic Therapy, EWDR, and Perioperative Considerations.Biomedicines · 2026Review
- Delphi Consensus on the Use of Fenofibrate as Systemic Therapy for the Prevention of Diabetic Retinopathy Progression.Journal of diabetes · 2026Article
- Knowledge and Awareness of Diabetic Retinopathy Among Patients Undergoing Fundus (Retina) Photography Screening at Primary Healthcare Centers in Bahrain.Journal of patient experience · 2026Article
- The Association of Lapses in Diabetic Retinopathy Care with Vision Impairment.Ophthalmology science · 2026Article
- Progression of diabetic retinopathy during pregnancy in a woman with ABCC8-MODY.Endocrinology, diabetes & metabolism case reports · 2026Article
- Oral therapies for diabetic retinopathy: Addressing an unmet need or a distant prospect?The Journal of international medical research · 2025Review
- Progress of diabetic retinopathy up to 24 years in patients with type 2 diabetes in Sweden: a cohort study from the Skaraborgs Diabetes Register.BMJ open diabetes research & care · 2025Article
- Novel Visceral Obesity Indicators and Associated Metabolic Fingerprint in Incident Diabetic Retinopathy.Investigative ophthalmology & visual science · 2025Article
15 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
1 author at 1 institution in 2 countries.
Funding
Abstract
The marked sentences are the ones the graph read a number from.
objectivesThis study investigated whether the beneficial effects of intensive glycemic control and fenofibrate treatment of dyslipidemia in reducing retinopathy progression demonstrated in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Eye Study persisted beyond the clinical trial. RESEARCH DESIGN AND
methodsThe ACCORD Study (2003-2009) randomized participants with type 2 diabetes to intensive or standard treatment for glycemia (A1C level at <6.0% [42 mmol/mol] vs. 7.0-7.9% [53-63 mmol/mol]), systolic blood pressure (<120 vs. 140 mmHg), and dyslipidemia (fenofibrate [160 mg] plus simvastatin or placebo plus simvastatin). ACCORD Eye Study participants, who had baseline and year 4 eye examinations and fundus photographs, were reexamined in the ACCORD Follow-On (ACCORDION) Eye Study (2010-2014) 4 years after the ACCORD trial closeout. The outcome measure was diabetic retinopathy progression of three or more steps on the Early Treatment Diabetic Retinopathy Study scale.
resultsDiabetic retinopathy progressed in 5.8% with intensive glycemic treatment versus 12.7% with standard (adjusted odds ratio [aOR] 0.42, 95% CI 0.28-0.63, P < 0.0001), 7.5% with intensive blood pressure treatment versus 6.0% for standard (aOR 1.21, 95% CI 0.61-2.40, P = 0.59), and 11.8% with fenofibrate versus 10.2% with placebo (aOR 1.13, 95% CI 0.71-1.79, P = 0.60) in ACCORDION Eye participants (n = 1,310).
conclusionsPrior intensive glycemic control continued to reduce diabetic retinopathy progression, despite similar A1C levels, when the ACCORD Study ended. This is the first study in people with type 2 diabetes of 10 years' duration and established cardiovascular disease, unlike the newly diagnosed participants of the UK Prospective Diabetes Study, to demonstrate this effect. The benefit of fenofibrate, however, did not persist. Intensive blood pressure control had no effect.
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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.