by Colin Kenny, GP, Dromore
A post hoc analysis of the ACCORD study has been published recently. Researchers wanted to understand the factors associated with the increased mortality in the intensively treated group. They looked at the renal function of participants at recruitment – 36% had chronic kidney disease (CKD) at stages 1–3 (people with CKD stages 4–5 were excluded). The subgroup with CKD had a higher mortality rate on intensive therapy than standard therapy.
Commenting on these finding, analysts have urged healthcare professionals to be especially cautious in pursuing tight glycaemic control in people with long-standing type 2 diabetes who have CKD. It has been pointed out that severe hypoglycaemia was more common in people with CKD who were randomised to tight glycaemic control, although it is not clear if this led directly to the increase in mortality rate.
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