Strategy reduced nephropathy risky by 21% in patients with type 2 diabetes, study finds
INTENSIVE GLUCOSE control with gliclazide (modified release) and other agents reduced the risk of nephropathy by one fifth in a large study of patients with type 2 diabetes.
The findings come from the ADVANCE trial (Action in Diabetes and Vascular Disease: Preterax
and Diamicron Modified Release Controlled Evaluation). Researchers randomly assigned 11,140 patients with type 2 diabetes to receive either standard or intensive glucose control, defined as the use of gliclazide (modified release) plus other drugs as needed to achieve a glycated hemoglobin level of 6.5% or less.
After a median follow-up of five years, the mean glycated hemoglobin level was lower in the intensive-control group than the standard-control group (6.5% vs. 7.3%), investigators reported in The New England Journal of Medicine (2008;358:2560-2572). Compared with the standard-control group, the intensive-control group had a 10% reduced risk of a combined outcome of major microvascular and macrovascular events. Microvascular events included new or worsening nephropathy or retinopathy and macrovascular events included death from cardiovascular causes, nonfatal MI, or nonfatal stroke.
The risk of major microvascular events was reduced by 14% in the intensive-control arm compared with the standard-control group, primarily because the intensive-control patients had a 21% reduced risk of nephropathy. The researchers observed no significant effect of intensive control on retinopathy.
Additionally, the study showed no significant effect of the type of glucose control on major macrovascular events (death from cardiovascular causes, nonfatal MI, or nonfatal stroke). More patients in the intensive-control group than the standard-control group experienced severe hypoglycemia (2.7% vs. 1.5%).
“The main benefit conferred by the ADVANCE treatment regimen was a one-fifth reduction in renal complications, indicating that intensive control of glucose has an important role in the prevention of microvascular complications of type 2 diabetes,” the authors concluded.