Intensive insulin for type 2 diabetes: The risk of causing harm

The ACCORD study showed that aggressive intensification of glycaemic control in patients with type 2 diabetes can increase mortality (hazard ratio [HR] 1·22, 95% CI 1·011·46), including death from cardiovascular causes (1·35, 1·041·76).1 The reason for this unexpected fi nding is unknown. Of note was the high percentage of intensively treated patients receiving insulin therapy (77%) or thiazolidinedione therapy (with or without insulin) (92%), and their greater weight gain (3·5 kg vs 0·4 kg).1 Results of post-hoc analyses did not support the hypothesis that increased hypoglycaemia in patients who were intensively treated caused the excess deaths.2 The analyses showed, however, that a higher baseline HbA1c and a failure to improve average HbA1c throughout the study were linked to the increased mortality.