1 / 20

Summary of ACCORD, ADVANCE, and VADT Trials

Summary of ACCORD, ADVANCE, and VADT Trials. ACCORD - Action to Control Cardiovascular Risk in Diabetes ADVANCE - Action in Diabetes to Prevent Vascular Disease VADT - Veterans Administration Diabetes Trail. Stephen Rith-Najarian, Diabetes Consultant Bemidji Area IHS.

jaxon
Télécharger la présentation

Summary of ACCORD, ADVANCE, and VADT Trials

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Summary ofACCORD, ADVANCE, and VADT Trials ACCORD - Action to Control Cardiovascular Risk in Diabetes ADVANCE - Action in Diabetes to Prevent Vascular Disease VADT - Veterans Administration Diabetes Trail Stephen Rith-Najarian, Diabetes Consultant Bemidji Area IHS ACCORD Study Group, NEJM 2008, 358:2545-2559. ADVANCE Collaborative Group, NEJM 2008, 358:2560-2572. VADT Study Results ADA Scientific Session San Francisco, 2008 In Press, Diabetes Obesity and Metabolism, 2008

  2. ACCORD, ADVANCE, and VADT • Background • Study Design and Results • Lessons Learned

  3. American Indian Mortality Rates Trends in Indian Health; Age-adjusted data

  4. Contribution of Diabetes to CHDStrong Heart Study Women Men Hazard Ratio 6.3 3.1 Prevalence 60% 50% Attributable risk 76% 51% Diabetes is the engine driving the increase in CVD

  5. UKPDS Myocardial Infarction (cumulative) 30% Conventional Intensive p=0.052 20% % of patients with an event 10% Risk reduction 16% (95% CI: 0 % to 29%) 0% 0 3 6 9 12 15 Years from randomization fatal or non fatal myocardial infarction, sudden death573 of 3867 patients (15%) UKPDS 35: Lancet. 1998, 352:837-53.

  6. UKPDS HbA1c trend cross-sectional, median values UKPDS 35: Lancet. 1998, 352:837-53.

  7. ACCORD, ADVANCE, and VADT TrialsResearch Question Does Intensive Glucose Control Reduce Risk for Cardiovascular Disease in Type 2 Diabetes? ACCORD Study Group, NEJM 2008, 358:2545-2559. ADVANCE Collaborative Group, NEJM 2008, 358:2560-2572. VADT Study Results ADA Scientific Session San Francisco, 2008 In Press, Diabetes Obesity and Metabolism, 2008

  8. ACCORD, ADVANCE, and VADT • Background • Study Design and Results • Lessons Learned

  9. ACCORD, ADVANCE and VADT Study Design ACCORD Study Group, NEJM 2008, 358:2545-2559. ADVANCE Collaborative Group, NEJM 2008, 358:2560-2572. VADT Study Results ADA Scientific Session San Francisco, 2008 In Press, Diabetes Obesity and Metabolism, 2008

  10. ACCORD, ADVANCE and VADTDemographics ACCORD Study Group, NEJM 2008, 358:2545-2559. ADVANCE Collaborative Group, NEJM 2008, 358:2560-2572. VADT Study Results ADA Scientific Session San Francisco, 2008 In Press, Diabetes Obesity and Metabolism, 2008

  11. ACCORD, ADVANCE and VADT Baseline Clinical Characteristics ACCORD Study Group, NEJM 2008, 358:2545-2559. ADVANCE Collaborative Group, NEJM 2008, 358:2560-2572. VADT Study Results ADA Scientific Session San Francisco, 2008 In Press, Diabetes Obesity and Metabolism, 2008

  12. Therapeutic Approach: ACCORD, ADVANCE and VADT ACCORD Study Group, NEJM 2008, 358:2545-2559. ADVANCE Collaborative Group, NEJM 2008, 358:2560-2572. VADT Study Results ADA Scientific Session San Francisco, 2008

  13. Outcomes: Summary of ACCORD, ADVANCE and VADT *ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial halted intensive glucose group (2/6/08) † significant difference between intensive and standard group ACCORD Study Group, NEJM 2008, 358:2545-2559. ADVANCE Collaborative Group, NEJM 2008, 358:2560-2572. VADT Study Results ADA Scientific Session San Francisco, 2008 In Press, Diabetes Obesity and Metabolism, 2008

  14. Adverse Outcomes: ACCORD, ADVANCE and VADT ACCORD Study Group, NEJM 2008, 358:2545-2559. ADVANCE Collaborative Group, NEJM 2008, 358:2560-2572. VADT Study Results ADA Scientific Session San Francisco, 2008 In Press, Diabetes Obesity and Metabolism, 2008

  15. Hazard Ratios for the Primary Outcome and Death from Any Cause in Pre-specified Subgroups: ACCORD Study Prior CVD Age <65 A1c >8.1 N Engl J Med 358;24, 2008

  16. ACCORD, ADVANCE, and VADT • Background • Study Design and Results • Lessons Learned

  17. ACCORD, ADVANCE, and VADT Lessons Learned • Intensive glucose control does not reduce CVD mortality in T2DM, and may increase risk, especially in patients with pre-existing CHD • Aggressive A1c targets (<6.5%) were associated with a 3-fold increased risk hypoglycemia • No excess CVD Mortality was seen with Rosigliatazone

  18. ACCORD, ADVANCE, and VADT Lessons Learned- Continued • Intensive control associated with reduced risk for nephropathy in ADVANCE. • To reach and maintain A1c targets of <6.5 required frequent adjustments of multiple anti-diabetic medications • Aggressive Targets (<6.5) are probably reasonable for healthy patients to reduce risk micro-vascular complications

  19. ADA Consensus Statement on Medical Management of Hyperglycemia in Type 2 Diabetes • Achieve and Maintain near normoglycemia, A1c <7.0 • Initiate Therapy with Lifestyle and Metformin • Rapid addition of medications, and transition to new regimens when targets are not achieved • Early addition of insulin therapy in patients who do not met target goals Nathan, Diabetes Care 2008;31:1-11

  20. ACCORD, ADVANCE, and VADT • Background • Study Design and Results • Lessons Learned

More Related