Counterpoint: Intensive Glucose Control and Mortality in ACCORD—Still Looking for Clues

E arly cessation of the intensive glycemic treatment arm of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial because of a 22% excess of all-cause mortality compared with the standard arm (1) came as an unpleasant surprise to many observers. Since then, considerable discussion of the significance of this result has ensued along with various theories as to why it occurred. In the companion article, a respected statistician, John Lachin, proposes yet another hypothesis: that the finding was due to the play of chance (2). In response, this article will address three related issues: 1) Dr. Lachin’s hypothesis; 2) a review of findings of post hoc analyses of the ACCORD data seeking support or lack of support for the other main theories; and 3) my own opinions on why continued study of the ACCORD data are needed, including a reformulation of one of the original theories regarding the cause of excess mortality.