Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes.

Abstract

The prevalence of diabetes is increasing worldwide, and most people with diabetes will die or be disabled as a consequence of vascular complications.1,2 Prospective studies have shown continuous associations of blood glucose and glycated hemoglobin levels with the risks of major vascular events.3,4 However, previous randomized trials evaluating the effects of glycemic control in patients with diabetes have provided inconsistent evidence of effects on vascular disease.5-11 Nevertheless, current guidelines recommend a target glycated hemoglobin level of 7.0% or less for most patients with diabetes.12-14 The Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial was designed to assess the effects on major vascular outcomes of lowering the glycated hemoglobin value to a target of 6.5% or less in a broad cross-section of patients with type 2 diabetes. The part of the study that evaluated the lowering of blood pressure with the use of perindopril and indapamide, completed in June 2007, showed a reduction in the risks of major vascular events and death, regardless of the initial blood pressure.15 Here we report the main results from the comparison of the blood-glucose-lowering strategies, completed in January 2008, which evaluated an intensive glucose-control strategy based on gliclazide (modified release) and other drugs as required to achieve the target glycated hemoglobin level.