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Further analysis of ACCORD data has supported individualization of A1C targets.
In the ACCORD data presented here, presence of diabetic retinopathy was associated with lower MMSE score, but severity of retinopathy was not.
In response, this article will address three related issues: 1) Dr. Lachin's hypothesis; 2) a review of findings of post hoc analyses of the ACCORD data seeking support or lack of support for the other main theories; and 3) my own opinions on why continued study of the ACCORD data are needed, including a reformulation of one of the original theories regarding the cause of excess mortality.
In the Bonds et al. (16) analysis on ACCORD data, more deaths among the patients who had experienced hypoglycemia were observed (HR 1.41 within the intensive glucose control arm and 2.30 within the standard glucose control arm), whereas in our study, a significantly different all-cause mortality rate was not found in the hypoglycemia group after controlling for the covariates.
However, the ACCORD data, together with post hoc analyses of three other fibrate trials, suggest that, when TG is >200 mg/dL and HDL is <35 mg/dL after statin therapy has significantly reduced LDL cholesterol levels, fibrate treatment can be considered, at least in men.
Although the analysis of the ACCORD data did not support the hypothesis that the increased mortality in the study was a result of hypoglycemia, the fact that hypoglycemia may often be asymptomatic leaves us with the possibility that it may be responsible.
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