Intensive Glucose Control in Diabetics Offers No Survival Advantage

But targeting an HbA1c level below 6.5% is associated with a decreased risk of ESRD.
But targeting an HbA1c level below 6.5% is associated with a decreased risk of ESRD.

Intensive rather than standard glucose control does not improve survival in patients with type 2 diabetes, but it does lower the risk of end-stage renal disease (ESRD), according to a 6-year follow-up of the ADVANCE trial.

From 2001 to 2003, the ADVANCE [Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation] trial enrolled 11,140 type 2 diabetics aged 55 years and older who had at least 1 additional risk factor for cardiovascular disease.

The study evaluated the effects of routine blood-pressure (BP) lowering and intensive versus standard glucose control. The study, which ended in January 2008, found that intensive glucose control targeting an HbA1c level of less than 6.5% did not decrease all-cause mortality or lower the risk of serious macrovascular events.

The study also showed that BP lowering with a fixed-dose combination of perindopril and indapamide significantly decreased the risk of all-cause and cardiovascular mortality.

The 6-year follow-up, conducted by Sophia Zoungas, MD, PhD, from the George Institute for Global Health in Camperdown, New South Wales, Australia, and colleagues, confirmed the findings. The primary endpoints of the new analysis were all-cause mortality and major macrovascular events. The 8,494 patients included in the analysis had a median follow-up of 5.9 years for the BP-lowering comparison and 5.4 years for the glucose-control comparison.

The group that received the BP-lowering treatment during the trial had an 8% decreased risk of all-cause mortality and a 12% decreased risk of cardiovascular mortality. These decreases were smaller than observed at the end of the original study, but still significant.

The follow-up analysis found no significant differences in all-cause mortality or major macrovascular events (a composite of nonfatal myocardial infarction, nonfatal stroke, or death from any cardiovascular cause) between the intensive-glucose-control and standard-glucose-control groups.

With respect to secondary outcomes, the intensive-glucose-control group experienced a significant 46% decreased risk of ESRD compared with the standard-glucose-control group. The 2 groups did not differ significantly in their risk of serious eye complications.

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