Effects of Intensive Glycemic Control on Clinical Outcomes Among Patients With Type 2 Diabetes With Different Levels of Cardiovascular Risk and Hemoglobin A1c in the ADVANCE Trial.

Abstract

OBJECTIVE:

To study whether the effects of intensive glycemic control on major vascular outcomes (a composite of major macrovascular and major microvascular events), all-cause mortality, and severe hypoglycemia events differ among participants with different levels of 10-year risk of atherosclerotic cardiovascular disease (ASCVD) and hemoglobin A1c (HbA1c) at baseline.

RESEARCH DESIGN AND METHODS:

We studied the effects of more intensive glycemic control in 11,071 patients with type 2 diabetes (T2D), without missing values, in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial, using Cox models.

RESULTS:

During 5 years' follow-up, intensive glycemic control reduced major vascular events (hazard ratio [HR] 0.90 [95% CI 0.83-0.98]), with the major driver being a reduction in the development of macroalbuminuria. There was no evidence of differences in the effect, regardless of baseline ASCVD risk or HbA1c level (P for interaction = 0.29 and 0.94, respectively). Similarly, the beneficial effects of intensive glycemic control on all-cause mortality were not significantly different across baseline ASCVD risk (P = 0.15) or HbA1c levels (P = 0.87). The risks of severe hypoglycemic events were higher in the intensive glycemic control group compared with the standard glycemic control group (HR 1.85 [1.41-2.42]), with no significant heterogeneity across subgroups defined by ASCVD risk or HbA1c at baseline (P = 0.09 and 0.18, respectively).

CONCLUSIONS:

The major benefits for patients with T2D in ADVANCE did not substantially differ across levels of baseline ASCVD risk and HbA1c.

• Authors: Jingyan Tian, Toshiaki Ohkuma, Mark Cooper, Stephen Harrap, Giuseppe Mancia, Neil Poulter, Ji-Guang Wang, Sophia Zoungas, Mark Woodward, John Chalmers
• Journal: Diabetes care (Diabetes Care) Vol. 43 Issue 6 Pg. 1293-1299 (06 2020) ISSN: 1935-5548 [Electronic] United States
• PMID: 32193249 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2020 by the American Diabetes Association.

Chemical References

• Blood Glucose
• Delayed-Action Preparations
• Drug Combinations
• Glycated Hemoglobin A
• Hypoglycemic Agents
• indapamide, perindopril drug combination
• Indapamide
• Gliclazide
• Perindopril

Topics

• Aged
• Blood Glucose (metabolism)
• Cardiovascular Diseases (etiology, prevention & control)
• Delayed-Action Preparations (therapeutic use)
• Diabetes Mellitus, Type 2 (blood, complications, diagnosis, drug therapy)
• Double-Blind Method
• Drug Combinations
• Female
• Gliclazide (therapeutic use)
• Glycated Hemoglobin (analysis, metabolism)
• Glycemic Control (methods)
• Heart Disease Risk Factors
• Humans
• Hypoglycemic Agents (therapeutic use)
• Indapamide (therapeutic use)
• Male
• Middle Aged
• Perindopril (therapeutic use)
• Prognosis
• Risk Factors
• Treatment Outcome