Drake T C, Hsu F-C, Hire D, Chen S-H, Cohen R M, McDuffie R, Nylen E, O'Connor P, Rehman S, Seaquist E R
Division of Endocrinology and Diabetes, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Diabetes Obes Metab. 2016 Jan;18(1):92-5. doi: 10.1111/dom.12569. Epub 2015 Oct 26.
The aim of this study was to identify the clinical features of participants in the standard therapy arm of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) glycaemia trial who failed to reach the glycated haemoglobin (HbA1c) target. We analysed 4685 participants in the standard therapy arm, comparing participants who reached the HbA1c target of <8.0% with those whose HbA1c level was ≥8.0% 12 months after randomization. Baseline and 12-month clinical characteristics were compared. At 12 months after randomization, 3194 participants had HbA1c <8.0% and 1491 had HbA1c ≥8.0%. Black race [odds ratio (OR) 0.74, 95% confidence interval (CI) 0.61-0.89; p = 0.002], severe hypoglycaemia (OR 0.57, CI 0.37-0.89; p = 0.014) and insulin use (OR 0.51, CI 0.40-0.65; p < 0.001) were associated with failure to reach HbA1c goal at 12 months in the adjusted model. Even with free medications, free visits with clinicians and aggressive titration of medications, >30% of participants in the standard arm of the ACCORD trial had an HbA1c ≥8.0% at 1 year. Participants who were black, had severe hypoglycaemia and were on insulin were more likely to have an above-target HbA1c concentration after 12 months on the standard protocol.
本研究的目的是确定糖尿病心血管风险控制行动（ACCORD）血糖试验标准治疗组中未达到糖化血红蛋白（HbA1c）目标的参与者的临床特征。我们分析了标准治疗组中的4685名参与者，比较了随机分组后12个月时达到HbA1c目标<8.0%的参与者与HbA1c水平≥8.0%的参与者。比较了基线和12个月时的临床特征。随机分组后12个月时，3194名参与者的HbA1c<8.0%，1491名参与者的HbA1c≥8.0%。在调整模型中，黑人种族[优势比（OR）0.74，95%置信区间（CI）0.61-0.89；p = 0.002]、严重低血糖（OR 0.57，CI 0.37-0.89；p = 0.014）和使用胰岛素（OR 0.51，CI 0.40-0.65；p < 0.001）与12个月时未达到HbA1c目标相关。即使有免费药物、免费看诊以及积极调整药物剂量，ACCORD试验标准治疗组中仍有超过30%的参与者在1年时HbA1c≥8.0%。在标准治疗方案治疗12个月后，黑人、有严重低血糖且使用胰岛素的参与者更有可能出现HbA1c浓度高于目标值的情况。
