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Persistent effects of intensive glycaemic control on retinopathy in T2D

Investigators have recently published a long-term follow up of the ACCORD (Action to Control Cardiovascular Risk in Diabetes) study. In the ACCORD Follow-On Eye Study subgroup, participants who had retinal photographs taken in the ACCORD Study were evaluated. The investigators followed this group for 8 years after randomisation using fundus photographs. They concluded that intensive glycaemic control conferred enduring protection from progression of diabetic retinopathy, even though the HbA1c levels were similar in the intensive and standard treatment groups 4 years after the cessation of the clinical trial.

By Colin Kenny, GP, Dromore

The original ACCORD Study (2003–2009) randomised 10,251 participants with type 2 diabetes to have intensive or standard treatment for hyperglycaemia. The study was controversial as there was a higher observed death rate in the intensive treatment arm compared with the standard glycaemic control arm. In the ACCORD Follow-On Eye Study, a subgroup of 2856 participants had baseline and yearly eye examinations and fundus photographs.

Diabetic retinopathy progressed in 5.8% of participants who had been in the intensive glycaemic treatment arm and 12.7% from the standard treatment arm. The investigators concluded that prior intensive glycaemic control continued to reduce diabetic retinopathy progression, despite similar HbA1c levels, after the ACCORD Study ended. This is the first study in people with type 2 diabetes of 10 years’ duration and established cardiovascular disease that has demonstrated this effect.

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