Annual training, menus of approaches for intensification, regular electronic messaging, audits of achieved glycemia, and central feedback to sites support glycemic intensification strategies in intensive participants.
Few intensive participants experienced weight gain and increased A1C.
Intensive participants who never took insulin or a TZD (n = 95) had an average weight loss of 2.9 kg during the first 2 years of the trial.
During outpatient SAP, continuous glucose monitor (CGM) use decreased over time, and at 12 months, only 33% of intensive participants averaged sensor use ≥6 days/week.
Intensive participants who never took insulin or a TZD had an average weight loss of 2.9 kg during the first 2 years of the trial.
An age subgroup comparison of medication used to achieve these levels prior to the transition of intensive participants to standard therapy identified that a lower percentage of older versus younger intensive glycemia participants were prescribed metformin (66.6% older, 79.3% younger), any secretagogue (57.7% older, 63.9% younger), and any thiazolidinedione (49% older, 57% younger).
In contrast, intensive participants who had never previously used insulin or TZD but began this combination after enrolling in the ACCORD trial had a weight gain of 4.6 5.3 kg at 2 years.
In contrast, intensive participants who had never previously used insulin or TZD but began this combination at some time after enrolling in the ACCORD trial had a weight gain of 4.6 to 5.3 kg at 2 years.
Because this seemed inconsistently effective, our group at OHSU eventually stressed testing before meals and at bedtime and based adjustments of mealtime insulin on these values and the anticipated size of each meal for most intensive participants.
While the older subgroup that was treated intensively displays a large elevation in the mortality rate for those with little reduction in A1C levels (Fig. 3 D ), this elevation must be considered within the context of the variability in estimates; only 6 deaths and 219 person-years of follow-up occurred among intensive participants with an increase in A1C during the initial 12 months.
