ACCORD Examines Three Strategies
In the United States there are about 17 million individuals who have been diagnosed with diabetes. 90 percent of them have type 2 diabetes which has formerly been called adult onset or non-insulin dependent diabetes. The prevalence of this disease is growing rapidly. By 2050, the number of Americans with diagnosed diabetes is projected to increase by 165 percent to 29 million, of whom 27 million will have the type 2 form.
Cardiovascular disease (CVD) is the leading cause of death in people with type 2 diabetes, with individuals dying of CVD at rates two to four times higher than those without the disease. Diabetics also have more nonfatal heart attacks and strokes.
Type 2 diabetes, associated with older age, is more common in individuals with the following characteristics or conditions:
- overweight or obese and have a family history of diabetes
- women with a history of diabetes during pregnancy
- adults with impaired glucose tolerance
- people with a sedentary lifestyle, and
- members of a minority race/ethnicity are also at a greater risk for developing type 2 diabetes. African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Pacific Islanders are at particularly high risk for type 2 diabetes.
ACCORD, which has enrolled 100,000 people nationally, tests the following three strategies:
(1) Blood sugar - ACCORD will determine whether lowering blood glucose to a level closer to normal than called for in current guidelines reduces CVD risk. The study will determine effects on CVD of that level compared with a level that is usually targeted.
(2) Blood pressure - Many people with type 2 diabetes have high blood pressure. The blood pressure part of the trial will determine the effects of lowering blood pressure in the context of good blood sugar control. ACCORD will determine whether lowering blood pressure to normal (systolic pressure less than 120 mm Hg) will better reduce CVD risk, as compared to a usually-targeted level in current clinical practice (i.e., below the definition of hypertension; systolic pressure less than 140 mm Hg).
(3) Blood Fats - Many people with diabetes have high levels of LDL ("bad") cholesterol and triglycerides, as well as low levels of HDL ("good") cholesterol. ACCORD participants who are selected for this part of the trial will be assigned to an intervention that improves blood fat levels. This part of the study will look at the effects of lowering LDL cholesterol and blood triglycerides and increasing HDL cholesterol compared to an intervention that only lowers LDL cholesterol, all in the context of good blood sugar control. A drug from a class of drugs called "fibrates" will be used to lower triglycerides and increase HDL cholesterol, whereas a drug from the class of drugs called "statins" will be used to lower LDL cholesterol.