Meeting News Coverage

ACCORDION: Intensive blood glucose control lowers risk for diabetic retinopathy

NEW ORLEANS — The risk for diabetic retinopathy is cut in half in people with type 2 diabetes who intensively control their blood glucose, according to results from the ACCORDION study.

“This study sends a powerful message to people with type 2 diabetes who worry about losing vision,” Emily Chew, MD, deputy director of the National Eye Institute’s division of epidemiology and clinical applications, said in a press release. “Well-controlled glycemia, or blood sugar level, has a positive, measurable and lasting effect on eye health.”

Chew and colleagues evaluated 1,310 people who participated in ACCORD to determine the effect of intensive glucose control and fenofibrate treatment for dyslipidemia on the risk for diabetic retinopathy progression.

During the ACCORD study from 2003 to 2009, participants were randomly assigned to intensive or standard treatment for glycemia (HbA1c targets < 6% vs. 7%), systolic blood pressure (< 120 mm Hg vs. 140 mm Hg) and dyslipidemia (fenofibrate 160 mg plus simvastatin or placebo plus simvastatin). Researchers examined participants with baseline and year 4 eye examinations and fundus photographs 4 years after ACCORD (2010-2014).

At year 8 from the beginning of ACCORD, the rates of progression to diabetic retinopathy were lower among the fenofibrate group (11.8%) compared with the placebo group (10.2%; adjusted OR = 1.13; 95% CI, 0.71-1.79). Similarly, the rates for progression to diabetic retinopathy were lower among the intensive glycemic control group (5.8%) compared with the standard glycemic treatment group (12.7%; aOR = 0.42; 95% CI, 0.28-0.63). However, the odds for progression were greater among the intensive BP control group (7.5%) compared with the standard BP control group (6%; aOR = 1.21; 95% CI, 0.61-2.4).

“Our study results provide evidence that intensive glycemic control is beneficial for reducing the progression of diabetic retinopathy and that the legacy effect is evident in people with type 2 diabetes,” the researchers wrote. “ACCORD previously reported that 3.7 years of intensive glycemic control reduced progression of albuminuria as well as neuropathy during the treatment period and at 1.3 years after cessation of treatment. The addition of the ACCORDION retinal results on these prior findings demonstrate a posttreatment benefit of intensive glycemic control on the progression of eye, kidney and nerve disease. There is also evidence that the beneficial effect of fenofibrate on diabetic retinopathy in the ACCORD Eye Study may be real but requires continued used of this treatment to maintain benefit. Therefore, it may be important to reconsider the use of fenofibrate for the treatment of diabetic retinopathy.” – by Amber Cox

Reference s :

Chew EY. Persistent effect of intensive glucose control on diabetic retinopathy in type 2 diabetes — The ACCORD Follow-on Study. Presented at: American Diabetes Association’s Scientific Sessions; June 10-14, 2016; New Orleans.

The Action to Control Cardiovascular Risk in Diabetes Follow-On (ACCORDION) Eye Study Group and the Action to Control Cardiovascular Risk in Diabetes Follow-On (ACCORDION) Study Group. Diabetes Care. 2016;doi:10.2337/dc16-0024.

Disclosure: Chew reports no relevant financial disclosures.

NEW ORLEANS — The risk for diabetic retinopathy is cut in half in people with type 2 diabetes who intensively control their blood glucose, according to results from the ACCORDION study.

“This study sends a powerful message to people with type 2 diabetes who worry about losing vision,” Emily Chew, MD, deputy director of the National Eye Institute’s division of epidemiology and clinical applications, said in a press release. “Well-controlled glycemia, or blood sugar level, has a positive, measurable and lasting effect on eye health.”

Chew and colleagues evaluated 1,310 people who participated in ACCORD to determine the effect of intensive glucose control and fenofibrate treatment for dyslipidemia on the risk for diabetic retinopathy progression.

During the ACCORD study from 2003 to 2009, participants were randomly assigned to intensive or standard treatment for glycemia (HbA1c targets < 6% vs. 7%), systolic blood pressure (< 120 mm Hg vs. 140 mm Hg) and dyslipidemia (fenofibrate 160 mg plus simvastatin or placebo plus simvastatin). Researchers examined participants with baseline and year 4 eye examinations and fundus photographs 4 years after ACCORD (2010-2014).

At year 8 from the beginning of ACCORD, the rates of progression to diabetic retinopathy were lower among the fenofibrate group (11.8%) compared with the placebo group (10.2%; adjusted OR = 1.13; 95% CI, 0.71-1.79). Similarly, the rates for progression to diabetic retinopathy were lower among the intensive glycemic control group (5.8%) compared with the standard glycemic treatment group (12.7%; aOR = 0.42; 95% CI, 0.28-0.63). However, the odds for progression were greater among the intensive BP control group (7.5%) compared with the standard BP control group (6%; aOR = 1.21; 95% CI, 0.61-2.4).

“Our study results provide evidence that intensive glycemic control is beneficial for reducing the progression of diabetic retinopathy and that the legacy effect is evident in people with type 2 diabetes,” the researchers wrote. “ACCORD previously reported that 3.7 years of intensive glycemic control reduced progression of albuminuria as well as neuropathy during the treatment period and at 1.3 years after cessation of treatment. The addition of the ACCORDION retinal results on these prior findings demonstrate a posttreatment benefit of intensive glycemic control on the progression of eye, kidney and nerve disease. There is also evidence that the beneficial effect of fenofibrate on diabetic retinopathy in the ACCORD Eye Study may be real but requires continued used of this treatment to maintain benefit. Therefore, it may be important to reconsider the use of fenofibrate for the treatment of diabetic retinopathy.” – by Amber Cox

Reference s :

Chew EY. Persistent effect of intensive glucose control on diabetic retinopathy in type 2 diabetes — The ACCORD Follow-on Study. Presented at: American Diabetes Association’s Scientific Sessions; June 10-14, 2016; New Orleans.

The Action to Control Cardiovascular Risk in Diabetes Follow-On (ACCORDION) Eye Study Group and the Action to Control Cardiovascular Risk in Diabetes Follow-On (ACCORDION) Study Group. Diabetes Care. 2016;doi:10.2337/dc16-0024.

Disclosure: Chew reports no relevant financial disclosures.

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