Approche multirisque du patient diabetique de type 2: desaccord sur les valeurs cibles suite a l'etude ACCORD.

Blood Pressure; Cardiovascular Diseases/prevention & control; Clinical Trials as Topic; Diabetes Mellitus, Type 2/blood/drug therapy; Hemoglobin A, Glycosylated/analysis; Humans; Hypoglycemic Agents/therapeutic use; Lipids/blood

Abstract :

[en] The ACCORD trial investigated the effects of intensifying the global management of 10,251 type 2 diabetic patients, with established cardiovascular disease or at least two other cardiovascular risk factors, on a composite endpoint (non fatal myocardial infarction, stroke and cardiovascular death). The attempt to reduce HbA1c level below 6% was associated with an increased cardiovascular mortality (despite a reduction in non fatal myocardial infarcts); lowering systolic blood pressure below 120 mmHg instead of 140 mmHg did not provide any additional benefit; finally, the control of atherogenic dyslipidaemia, with fenofibrate added to a statin, did not modify the composite endpoint (despite a positive effect in the subgroup of patients with high triglycerides and low HDL cholesterol). These rather disappointing results should be interpreted to provide practical guidelines.
[fr] L’étude ACCORD a évalué les effets d’une intensification de la prise en charge de 10.251 patients diabétiques de type 2, avec une maladie cardiovasculaire établie ou au moins deux autres facteurs de risque, sur un critère composite (infarctus non mortels, accidents vasculaires cérébraux non mortels et décès d’origine cardiovasculaire). L’intensification du traitement hypoglycémiant (visant une HbA1c < 6 %), du traitement antihypertenseur (visant une pression systolique < 120 mm Hg) et/ou du traitement hypolipidémiant (ajout de fénofibrate à une statine) n’a pas modifié significativement le critère primaire. Un excès de mortalité cardiovasculaire (malgré moins d’infarctus non mortels) a fait interrompre prématurément le bras intensif glycémie. Ces résultats décevants doivent être interprétés pour formuler des recommandations pratiques.

Disciplines :

Cardiovascular & respiratory systems
Pharmacy, pharmacology & toxicology
Endocrinology, metabolism & nutrition

Author, co-author :

Scheen, André ; Université de Liège - ULiège > Département des sciences cliniques > Diabétologie, nutrition et maladie métaboliques - Médecine interne générale

Paquot, Nicolas ; Centre Hospitalier Universitaire de Liège - CHU > Diabétologie,nutrition, maladies métaboliques

Language :

French

Title :

Approche multirisque du patient diabetique de type 2: desaccord sur les valeurs cibles suite a l'etude ACCORD.

Alternative titles :

[en] Multirisk approach of the type 2 diabetic patient: controversies surrounding target values after the ACCORD trial

Publication date :

2010

Journal title :

Revue Médicale Suisse

ISSN :

1660-9379

Publisher :

Medecine et Hygiène, Switzerland

Volume :

Issue :

260

Pages :

1582-7

Peer reviewed :

Peer Reviewed verified by ORBi

Additional URL :

http://rms.medhyg.ch/resume.php?ID_ARTICLE=RMS_260_1582#hit1

Available on ORBi :

since 15 January 2011

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