Evaluating How the Treatments in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Study Affect Diabetic Retinopathy (The ACCORD Eye Study)

NCT ID: NCT00542178

Last Updated: 2018-07-24

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

3472 participants

Study Classification

INTERVENTIONAL

Study Start Date

2003-10-31

Study Completion Date

2009-12-31

Brief Summary

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Diabetic retinopathy (DR) is an eye disease that can occur in people with diabetes and can cause poor vision or blindness. The Action to Control Cardiovascular Risk in Diabetes (ACCORD) study is examining the effect of various treatments on cardiovascular disease in people with diabetes. This current study will examine the effects of the ACCORD treatments on the progression of DR in people participating in the ACCORD study.

Detailed Description

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DR is the most common diabetic eye disease and is the leading cause of blindness in adults in the United States. It is caused by damage to the blood vessels of the retina, which is the light-sensitive outer layer of the eye. Retinal blood vessels are often affected by the high blood sugar levels associated with diabetes. Older people have an increased risk of developing DR; however, DR is likely to occur earlier and be more severe in anyone who has poorly controlled diabetes. Almost everyone who has had diabetes for more than 30 years will eventually show signs of DR. Symptoms of DR include poor night vision, seeing spots in front of the eyes, blurred vision, and blindness. The ACCORD study is a study that is examining the effects of different treatments on cardiovascular disease in people with diabetes. Participants in the ACCORD study will receive one of eight different combinations of treatment, including blood sugar control, blood pressure control, and cholesterol-controlling medication. This study will enroll participants in the ACCORD study and will examine the effects of the study treatments on DR. The results from this study may be used to develop new treatments to help prevent diabetes-related blindness.

Study visits will occur at baseline and Year 4. At each study visit, participants will have an eye exam and specialized fundus photographs taken of the back of the eye and retina.

Conditions

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Diabetic Retinopathy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

PREVENTION

Blinding Strategy

DOUBLE

Participants Investigators

Study Groups

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Intensive glycemia control

A strategy of intensive glycemia treatment to HbA1c less than 6%

Group Type EXPERIMENTAL

Hypoglycemic Agents

Intervention Type DRUG

Multiple drugs including insulins and oral hypoglycemia agents for HbA1c less than 6%

Standard glycemia control

A strategy of multiple drugs to treat HbA1c to 7.0% - 7.9%

Group Type ACTIVE_COMPARATOR

Standard glycemia control

Intervention Type DRUG

A strategy of glycemia drugs for HbA1c 7% - 7.9%

Intensive BP control

A strategy of BP treatment for SBP less than 120 mm Hg

Group Type EXPERIMENTAL

Intensive BP treatment

Intervention Type DRUG

A strategy of multiple BP agents to reduce SBP less than 120 mm Hg

Standard BP control

A strategy of BP treatment for SBP less than 140 mm Hg

Group Type ACTIVE_COMPARATOR

Standard BP control

Intervention Type DRUG

A strategy of BP drugs for SBP less than 140 mm Hg

Fibrate

Blinded fenofibrate + simvastatin 20-40 mg/d

Group Type EXPERIMENTAL

Fenofibrate

Intervention Type DRUG

Blinded fenofibrate

Simvastatin

Intervention Type DRUG

Simvastatin 20-40 mg/d

Fibrate Placebo

Blinded placebo + simvastatin 20-40 mg/d

Group Type PLACEBO_COMPARATOR

Simvastatin

Intervention Type DRUG

Simvastatin 20-40 mg/d

Placebo

Intervention Type DRUG

Placebo

Interventions

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Hypoglycemic Agents

Multiple drugs including insulins and oral hypoglycemia agents for HbA1c less than 6%

Intervention Type DRUG

Standard glycemia control

A strategy of glycemia drugs for HbA1c 7% - 7.9%

Intervention Type DRUG

Intensive BP treatment

A strategy of multiple BP agents to reduce SBP less than 120 mm Hg

Intervention Type DRUG

Standard BP control

A strategy of BP drugs for SBP less than 140 mm Hg

Intervention Type DRUG

Fenofibrate

Blinded fenofibrate

Intervention Type DRUG

Simvastatin

Simvastatin 20-40 mg/d

Intervention Type DRUG

Placebo

Placebo

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Participating in the ACCORD study

Exclusion Criteria

* Has had laser photocoagulation for DR
* Has had vitrectomy surgery for DR
Minimum Eligible Age

40 Years

Maximum Eligible Age

79 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Eye Institute (NEI)

NIH

Sponsor Role collaborator

National Heart, Lung, and Blood Institute (NHLBI)

NIH

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Walter T. Ambrosius, PhD

Role: PRINCIPAL_INVESTIGATOR

Wake Forest University Health Sciences

Emily Y. Chew, MD

Role: PRINCIPAL_INVESTIGATOR

National Eye Institute (NEI)

Locations

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The Berman Center for Clinical Research

Minneapolis, Minnesota, United States

Site Status

Columbia University

New York, New York, United States

Site Status

Wake Forest University Health Sciences

Winston-Salem, North Carolina, United States

Site Status

Case Western Reserve University

Cleveland, Ohio, United States

Site Status

Veterans Affairs

Memphis, Tennessee, United States

Site Status

University of Washington

Seattle, Washington, United States

Site Status

McMaster University

Hamilton, Ontario, Canada

Site Status

Countries

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United States Canada

References

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Chew EY, Ambrosius WT, Howard LT, Greven CM, Johnson S, Danis RP, Davis MD, Genuth S, Domanski M; ACCORD Study Group. Rationale, design, and methods of the Action to Control Cardiovascular Risk in Diabetes Eye Study (ACCORD-EYE). Am J Cardiol. 2007 Jun 18;99(12A):103i-111i. doi: 10.1016/j.amjcard.2007.03.028. Epub 2007 Apr 13.

Reference Type BACKGROUND
PMID: 17599420 (View on PubMed)

ACCORD Study Group; ACCORD Eye Study Group; Chew EY, Ambrosius WT, Davis MD, Danis RP, Gangaputra S, Greven CM, Hubbard L, Esser BA, Lovato JF, Perdue LH, Goff DC Jr, Cushman WC, Ginsberg HN, Elam MB, Genuth S, Gerstein HC, Schubart U, Fine LJ. Effects of medical therapies on retinopathy progression in type 2 diabetes. N Engl J Med. 2010 Jul 15;363(3):233-44. doi: 10.1056/NEJMoa1001288. Epub 2010 Jun 29.

Reference Type RESULT
PMID: 20587587 (View on PubMed)

Do DV, Han G, Abariga SA, Sleilati G, Vedula SS, Hawkins BS. Blood pressure control for diabetic retinopathy. Cochrane Database Syst Rev. 2023 Mar 28;3(3):CD006127. doi: 10.1002/14651858.CD006127.pub3.

Reference Type DERIVED
PMID: 36975019 (View on PubMed)

Action to Control Cardiovascular Risk in Diabetes Follow-On (ACCORDION) Eye Study Group and the Action to Control Cardiovascular Risk in Diabetes Follow-On (ACCORDION) Study Group. Persistent Effects of Intensive Glycemic Control on Retinopathy in Type 2 Diabetes in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Follow-On Study. Diabetes Care. 2016 Jul;39(7):1089-100. doi: 10.2337/dc16-0024. Epub 2016 Jun 11.

Reference Type DERIVED
PMID: 27289122 (View on PubMed)

Chew EY, Davis MD, Danis RP, Lovato JF, Perdue LH, Greven C, Genuth S, Goff DC, Leiter LA, Ismail-Beigi F, Ambrosius WT; Action to Control Cardiovascular Risk in Diabetes Eye Study Research Group. The effects of medical management on the progression of diabetic retinopathy in persons with type 2 diabetes: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Eye Study. Ophthalmology. 2014 Dec;121(12):2443-51. doi: 10.1016/j.ophtha.2014.07.019. Epub 2014 Aug 29.

Reference Type DERIVED
PMID: 25172198 (View on PubMed)

Wong TY, Simo R, Mitchell P. Fenofibrate - a potential systemic treatment for diabetic retinopathy? Am J Ophthalmol. 2012 Jul;154(1):6-12. doi: 10.1016/j.ajo.2012.03.013.

Reference Type DERIVED
PMID: 22709833 (View on PubMed)

Ambrosius WT, Danis RP, Goff DC Jr, Greven CM, Gerstein HC, Cohen RM, Riddle MC, Miller ME, Buse JB, Bonds DE, Peterson KA, Rosenberg YD, Perdue LH, Esser BA, Seaquist LA, Felicetta JV, Chew EY; ACCORD Study Group. Lack of association between thiazolidinediones and macular edema in type 2 diabetes: the ACCORD eye substudy. Arch Ophthalmol. 2010 Mar;128(3):312-8. doi: 10.1001/archophthalmol.2009.310.

Reference Type DERIVED
PMID: 20212201 (View on PubMed)

Related Links

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http://www.accordtrial.org/

Click here for the ACCORD Study Web site

Other Identifiers

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N01 HC095178-19

Identifier Type: -

Identifier Source: secondary_id

N01HC095178

Identifier Type: NIH

Identifier Source: secondary_id

View Link

509

Identifier Type: -

Identifier Source: org_study_id

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