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

被引：121

作者：

Chew, Emily Y. ^{[1
]}

Lovato, James F. ^{[2
]}

Davis, Matthew D. ^{[3
]}

Gerstein, Hertzel C. ^{[4
,5
]}

Danis, Ronald P. ^{[3
]}

Ismail-Beigi, Faramarz ^{[6
]}

Genuth, Saul ^{[6
]}

Greven, Craig M. ^{[2
]}

Perdue, Letitia H. ^{[2
]}

Cushman, William C.

Elam, Marshall B. ^{[7
]}

Bigger, J. Thomas ^{[8
]}

Ginsberg, Henry N. ^{[8
]}

Goff, David C., Jr. ^{[9
]}

Ambrosius, Walter T. ^{[2
]}

机构：

[1] NEI, NIH, Bethesda, MD 20892 USA

[2] Wake Forest Univ, Bowman Gray Sch Med, Winston Salem, NC USA

[3] Univ Wisconsin, Madison, WI USA

[4] McMaster Univ, Hamilton, ON, Canada

[5] Hamilton Hlth Sci, Populat Hlth Res Inst, Hamilton, ON, Canada

[6] Case Western Reserve Univ, Cleveland, OH 44106 USA

[7] Memphis Vet Affairs Med Ctr, Memphis, TN USA

[8] Columbia Univ Coll Phys & Surg, 630 W 168th St, New York, NY 10032 USA

[9] Colorado Sch Publ Hlth, Aurora, CO USA

来源：

DIABETES CARE | 2016年 / 39卷 / 07期

基金：

美国国家卫生研究院;

关键词：

FENOFIBRATE; PROGRESSION; THERAPY;

D O I：

10.2337/dc16-0024

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVES This 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 METHODS The 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. 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). CONCLUSIONS Prior 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.

引用

页码：1089 / 1100

页数：12

共 23 条

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