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.

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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.