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Strict diabetes control may protect at micro level

Intensive blood glucose control in type 2 diabetes confers no cardiovascular benefit over conventional treatment, although it may provide protection from microvascular damage, five-year results from the major ACCORD trial suggest.

The latest analysis is drawn from a randomised controlled trial of patients with type 2 diabetes treated to a HbA1c level of 6% or less or 7-7.9%. It comes as NICE prepares to modify its 7% QOF target for glycaemic control, amid concerns that intensive control could push up overall mortality.

Researchers compared rates of dialysis or renal transplantation, high serum creatinine, retinal damage or peripheral neuropathy, and 13 secondary outcomes of kidney, eye and peripheral nerve function were also measured.

Intensive therapy did not reduce the risk of advanced measures of microvascular damage. But intensive therapy did lead to a 21% reduction in development of albuminuria and a 21% reduction in the rate of cataract extraction.

Peripheral neuropathy was less common in the intensive treatment group, and there were more improvements in visual acuity and nerve function scores.

Study leader Dr Faramarz Ismail-Beigi, a clinical researcher at the Case Western Reserve University in the US, said despite the microvascular benefits ‘overall, targeting of HbA1c of 6.0% or less is not recommended'.

Dr Ronald Klein, a researcher in ophthalmology and visual sciences at the University of Wisconson, said: ‘The ACCORD findings do not support applying intensive glycaemic control in patients with diabetes at risk of cardiovascular disease. It might be the regimen used in ACCORD was more aggressive than is prudent. But it is important ACCORD's findings are not misinterpreted as a justification for a return to poor glycaemic control.'

Strict diabetes control may protect at micro level