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Indeed, in ACCORD, a 22% increase in total mortality with intensive therapy was observed, mainly driven by cardiovascular mortality.
To date no adequate explanation for these findings of increased mortality with intensive glycemic control has been identified.
Indeed, recent trials have shown either no significant reduction in CVD outcomes or increased mortality with intensive glycemic control [ 27].
51 Increased mortality with intensive compared with conventional glucose control was also observed in that trial; however, the cause of the increased mortality remains to be identified.
54 Excess mortality with intensive glycemic treatment in the recent megatrials could be potentially related to the negative effects of hypoglycemic events.
There remains a theoretical possibility that CAN was worsened by intensive treatment during the trial and did account for the increased mortality with intensive treatment.
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There is no corresponding evidence of an increased mortality risk with intensive BP treatment.
18 The ADVANCE and ACCORD studies and the VADT provide conflicting evidence of mortality risk with intensive glycemic control.
The recently reported increased mortality associated with intensive control of hyperglycemia in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial (3) has led to controversy about implementation of intensive glucose control in patients with type 2 diabetes.
Therapeutic options for older patients with acute myeloid leukemia (AML) are limited by the higher risk of treatment-related mortality associated with intensive chemotherapy and poor treatment outcomes, particularly in patients with an adverse risk karyotype and secondary AML.
These results are consistent with the primary analyses, except that the previously observed increase in mortality associated with intensive glycemia control seems limited to this subset of ACCORD participants.
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