Factors associated with failure to achieve a glycated haemoglobin target of <8.0% in the A ction to C ontrol C ardiovascular R isk in D iabetes ( ACCORD ) trial

The aim of this study was to identify the clinical features of participants in the standard therapy arm of the A ction to C ontrol C ardiovascular R isk in D iabetes ( ACCORD ) glycaemia trial who failed to reach the glycated haemoglobin ( HbA1c ) target. We analysed 4685 participants in the standard therapy arm, comparing participants who reached the HbA1c target of <8.0% with those whose HbA1c level was ≥8.0% 12 months after randomization. Baseline and 12‐month clinical characteristics were compared. At 12 months after randomization, 3194 participants had HbA1c <8.0% and 1491 had HbA1c ≥8.0%. Black race [odds ratio ( OR ) 0.74, 95% confidence interval ( CI ) 0.61–0.89; p = 0.002], severe hypoglycaemia ( OR 0.57, CI 0.37–0.89; p = 0.014) and insulin use ( OR 0.51, CI 0.40–0.65; p < 0.001) were associated with failure to reach HbA1c goal at 12 months in the adjusted model. Even with free medications, free visits with clinicians and aggressive titration of medications, >30% of participants in the standard arm of the ACCORD trial had an HbA1c ≥8.0% at 1 year. Participants who were black, had severe hypoglycaemia and were on insulin were more likely to have an above‐target HbA1c concentration after 12 months on the standard protocol.