Intensive glucose lowering (HbA1c target<6.0%) for people with type 2 diabetes increases mortality
Bibliographic record
Abstract
Commentary on: ACCORD Study Group, Gerstein HC, Miller ME, et al. Long-term effects of intensive glucose lowering on cardiovascular outcomes. N Engl J Med 2011;364:818–28.[OpenUrl][1][CrossRef][2][PubMed][3] The Action to Control Cardiovascular Risk in Diabetes (ACCORD)trial attempted to address the uncertainty that exists over whether intensively lowering blood glucose can reduce the significant excess of cardiovascular risk in people with type 2 diabetes. The trial was stopped after 3.5 years, because of an excess of deaths in the intensive glycaemia arm.1 The ACCORD investigators have now reported outcomes from an extended follow-up. The ACCORD trial recruited 10 251 patients with inadequately controlled type 2 diabetes (haemoglobin A1c (HbA1c)>7.5%) in the USA and Canada. Participants were aged 40–79 with either prior cardiovascular disease (CVD) or with CVD risk factors, had a mean diabetes duration of 10 years, and were randomised to either intensive blood glucose control (HbA1c target<6%) or standard control (HbA1c target 7.0–7.9%), to be … [1]: {openurl}?query=rft.jtitle%253DNew%2BEngland%2BJournal%2Bof%2BMedicine%26rft.stitle%253DNEJM%26rft.issn%253D0028-4793%26rft.volume%253D364%26rft.issue%253D9%26rft.spage%253D818%26rft.epage%253D828%26rft.atitle%253DLong-term%2Beffects%2Bof%2Bintensive%2Bglucose%2Blowering%2Bon%2Bcardiovascular%2Boutcomes.%26rft_id%253Dinfo%253Adoi%252F10.1056%252FNEJMoa1006524%26rft_id%253Dinfo%253Apmid%252F21366473%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1056/NEJMoa1006524&link_type=DOI [3]: /lookup/external-ref?access_num=21366473&link_type=MED&atom=%2Febmed%2F16%2F6%2F186.atom
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How this classification was reachedexpand
Direct model labels (unvalidated)
Per-model category and study-design labels from the labeling rounds. They are machine output, unvalidated, and the disagreement between models ships as data. No study design here is MEDLINE-validated yet.
| Model arm | Categories | Study design | Confidence |
|---|---|---|---|
| gemma | no category Domain: not available · Genre: Editorial About the Canadian research system: no · About a Canadian topic: no | Observational | medium |
| gpt | no category Domain: not available · Genre: Empirical About the Canadian research system: no · About a Canadian topic: no | Randomized trial | high |
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.044 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.005 | 0.001 |
| Research integrity | 0.023 | 0.023 |
| Insufficient payload (model declined to judge) | 0.028 | 0.022 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedLabeled directly by 2 models reading the full record.
The models disagree on parts of this classification; every voice is preserved in the section at the end of the page.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".