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The ACCORD glycemia trial tested whether targeting near-normal HbA1c in patients with type 2 diabetes at high cardiovascular risk would reduce major cardiovascular events. Intensive therapy lowered HbA1c more substantially than standard treatment, but the trial was stopped early because all-cause mortality was higher in the intensive-treatment group. The finding remains a foundational lesson in diabetes care: aggressive glucose lowering is not automatically associated with better survival, particularly in older, high-risk patients with long-standing disease and multiple comorbidities. For internists, treatment goals should therefore be individualized according to duration of diabetes, hypoglycemia risk, cardiovascular disease, kidney function, frailty and life expectancy. Modern therapies with demonstrated cardiovascular and renal benefits have also changed the therapeutic landscape since ACCORD. The study should be interpreted in its historical context while retaining its central clinical lesson—more intensive treatment is not necessarily better when the harms of polypharmacy and hypoglycemia outweigh incremental glycemic benefit.
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The ACCORD glycemia trial tested whether targeting near-normal HbA1c in patients with type 2 diabetes at high cardiovascular risk would reduce major cardiovascular events. Intensive therapy lowered HbA1c more substantially than standard treatment, but the trial was stopped early because all-cause mortality was higher in the intensive-treatment group. The finding remains a foundational lesson in diabetes care: aggressive glucose lowering is not automatically associated with better survival, particularly in older, high-risk patients with long-standing disease and multiple comorbidities. For internists, treatment goals should therefore be individualized according to duration of diabetes, hypoglycemia risk, cardiovascular disease, kidney function, frailty and life expectancy. Modern therapies with demonstrated cardiovascular and renal benefits have also changed the therapeutic landscape since ACCORD. The study should be interpreted in its historical context while retaining its central clinical lesson—more intensive treatment is not necessarily better when the harms of polypharmacy and hypoglycemia outweigh incremental glycemic benefit.
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