1、cross-sectional,median values 0678903691215HbA1c(%)Years from randomisationConventionalConventionalIntensiveIntensive6.2%upper limit of normal rangeAfter median 8.5 years post-trial follow-upAggregate Endpoint 19972007Any diabetes related endpointRRR:12%9%P:0.029 0.040 Microvascular diseaseRRR:25%24
2、%P:0.00990.001Myocardial infarctionRRR:16%15%P:0.0520.014All-cause mortalityRRR:6%13%P:0.440.007RRR=Relative Risk Reduction,P=Log Rank*p0.05 ACCORD Retinal ConclusionIntensive glycemic control and intensive combination treatment of dyslipidemia,but not intensive blood-pressure control,reduced the ra
3、te of progression of diabetic retinopathy.(Funded by the National Heart,Lung,and Blood Institute and others;ClinicalTrials.gov numbers,NCT00000620 for the ACCORD study and NCT00542178 for the ACCORD Eye study.)4.3 years of follow-up:Perindopril/indapamideBlood pressure reduced 7.1 0.3 mmHg systolic
4、and 2.9 0.2 mmHg diastolic(P 0.001).HbA1C was reduced by 0.61 0.02%after 4.3 years(P 0.001).Glicazide MRVADT ConclusionTime(years since diagnosis)HbA1c(%)6.06.57.07.58.08.59.09.512345678910111213141516Drive the risk for complicationsMean Systolic Blood-Pressure Levels at Each Study VisitThe ACCORD S
5、tudy Group.N Engl J Med 2010;362:1575-1585ACCORD BP ConclusionIn patients with type 2 diabetes at high risk for cardiovascular events,targeting a systolic blood pressure of less than 120 mm Hg,as compared with less than 140 mm Hg,did not reduce the rate of a composite outcome of fatal and nonfatal m
6、ajor cardiovascular eventsACCORD lipid ConclusionThe combination of fenofibrate and simvastatin did not reduce the rate of fatal cardiovascular events,nonfatal myocardial infarction,or nonfatal stroke,as compared with simvastatin aloneThese results do not support the routine use of combination thera
7、py with fenofibrate and simvastatin to reduce cardiovascular risk in the majority of high-risk patients with type 2 diabetesHazard Ratios for the Primary Outcome in Prespecified SubgroupsThe ACCORD Study Group.N Engl J Med 2010;362:1563-15742.01.51.00.51st Generation sulphonylureas v metformin2nd Ge
8、neration sulphonylureas v metforminAll rosiglitazone*v metforminAll pioglitazone*v metforminAll rosiglitazone*v all pioglitazone*Other combinations v metforminTzoulaki et al.,BMJ 2009;339:b4731Hazard Ratio(95%CI)(Log Scale)*Any therapy(monotherapy and combinations).Other drugs and combinations of an
9、y oral antidiabetes drugs excluding rosiglitazone and pioglitazoneModel 2 results1 ACCORD Study Group.Effects of Intensive Glucose Lowering in Type 2 Diabetes.N Engl J Med 2008;358:2545-59 2.ACCORD Webcast presented at the American Diabetes Association,6-10 June 2008.Available at:http:/www.diabetesc
10、onnect.org/StoreTemplate/default.aspx?ReturnUrl=%2fDefault.aspx 5.Cefalu,WT.N Engl J Med 2008;358(24):2633-2635.6.Avandia SPC March 2008A 40 year old lady has a 2 year history of type 2 diabetes.Her glycaemic control is consistently poor.She is an ex-smoker with a BMI of 49.Her current medication in
11、cludes Aspirin 75 mg OD,Lisinopril 20 mg OD,Simvastatin 20 mg OD,Metformin 850 mg BD.Examination reveal BP of 175/70 mm/hg,peripheral pulses are normal with no evidence of neuropathy.Fundoscopy reveals early background retinopathy.Hba1c-8.5%TC-5.7 mmol/l LDL-C-3.5 mmol/l HDL-C-0.9 mmol/l Plasma TG-2.6 mmol/l U/E-Normal LFT-NormalMicroalbuminuria screen-positive How would you further manage this patient?Ambery P et al.Poster presented at Diabetes UK annual professional conference,2005.P120.HbA1c 10%40%7%53%
