EASD 2020 Highlights

Conference summaries


Effects of intensive risk factor management on cardiovascular autonomic neuropathy in type 2 diabetes: findings from the ACCORD clinical trial

Presented by:

Rodica Pop-Busui, MD, PhD

  • Intensive blood glucose and BP interventions in T2D reduced the risk of CAN by 17% and 22%, respectively.
  • Intensive glycaemic control was more effective in patients without prior history of CVD, and BP lowering was more effective in patients ≥65 years.
  • However, these benefits must be weighed against increased risks and costs, and especially the excess mortality observed with intensive glycaemic control in ACCORD.


What do we already know about this topic?

  • Diabetic neuropathies are the most prevalent chronic complications of diabetes.1
  • Among the various forms of diabetic neuropathy, cardiovascular autonomic neuropathy (CAN) is one of the most studied.1
  • The early recognition and appropriate management of CAN in patients with diabetes is important since CAN independently predicts the progression of diabetic nephropathy and chronic kidney disease.1

How was this study conducted?

  • This study examined the effect of intensively treating hyperglycaemia, hypertension and dyslipidaemia on the risk of CAN in patients with type 2 diabetes (T2D).
  • The study considered data from the glycaemia trial, the blood pressure (BP) trial and the lipid trial in which 10,251 participants were randomized to standard or intensive glycaemic control.2

What does this study add?

  • During follow-up, there was a 17% reduction in risk of developing CAN in those undergoing intensive glycaemic control.
  • Intensive control of BP also reduced the risk of CAN by 22%.
  • Addition of fenofibrate to statin treatment did not appear to have beneficial effects on the risk of CAN.
  • Glycaemic intervention was particularly effective in those who had no prior CVD at baseline.
  • BP intervention was more effective in those over the age of 65 years.


How does this study impact clinical practice?

  • Intensive glycaemic control was most effective in T2D patients without prior history of CVD, and BP lowering was more effective in patients ≥65 years.
  • These benefits must be considered vis-à-vis the risks and costs associated with these interventions, including the excess mortality observed with intensive glycaemic control in ACCORD.



  1. Pop-Busui R, Boulton AJ, Feldman EL, Bril V, Freeman R, Malik RA, Sosenko JM, Ziegler D. Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes Care. 2017;40(1):136-54.
  2. Pop-Busui R, Evans GW, Gerstein HC, et al. Effects of cardiac autonomic dysfunction on mortality risk in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Diabetes Care. 2010;33(7):1578-84.


Related content


This is a highlights summary of an oral session given at the EASD 2020 Virtual Meeting and presented by:

Rodica Pop-Busui, MD, PhD
Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA

The presenting authors of the original session had no part in the creation of this conference highlights summary. 

The content is produced by Infomedica. The summary text was drafted by Patrick Moore, PhD, and reviewed by Marco Gallo, MD, an independent external expert, and approved by Florian Toti, MD, the scientific editor of the program.


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