Intensive Glycemic Control and Cardiovascular Outcomes: ADVANCE

The ADVANCE study of intensive versus standard glycemic control in type 2 diabetes found a statistically significant reduction in albuminuria with an A1C target of 6.5% (achieved median A1C 6.3%) compared with standard therapy achieving a median A1C of 7.0% (63) ADVANCE randomized participants to intensive glycemic control (with primary therapy being the sulfonylurea gliclazide and additional medications as needed to achieve a target A1C of 6.5%) or to standard therapy (in which any medication but gliclazide could be used and the glycemic target was according to “local guidelines”) Participants in ADVANCE were slightly older than those in ACCORD and VADT and had similar high CVD risk; however, they had an average duration of diabetes that was 2 years shorter, lower baseline A1C (median 7.2%), and almost no use of insulin at enrollment Median A1C levels achieved in the intensive and standard arms were 6.3 and 7.0%, respectively, and maximal separation between the arms took several years to achieve Use of other drugs that favorably impact CVD risk (aspirin, statins, and angiotensin enzyme inhibitors) was lower in ADVANCE than in ACCORD or VADT The primary outcome of ADVANCE was a combination of microvascular events (nephropathy and retinopathy) and major adverse cardiovascular events (MI, stroke, and cardiovascular death) Intensive glycemic control significantly reduced the primary end point, although this was due to a significant reduction in the microvascular outcome, primarily development of macroalbuminuria, with no significant reduction in the macrovascular outcome There was no difference in overall or cardiovascular mortality between the intensive compared with the standard glycemic control arms43Reference Patel A, MacMahon S, Chalmers J, et al., for the ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008;358:2560-2572.