Long-term Benefits of Intensive Glucose Control for Preventing End-Stage Kidney Disease: ADVANCE-ON

The Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial reported that intensive glucose control prevents end-stage kidney disease (ESKD) in patients with type 2 diabetes, but uncertainty about the balance between risks and benefits exists. Here, w...

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Veröffentlicht in:Diabetes care Jg. 39; H. 5; S. 694
Hauptverfasser: Wong, Muh Geot, Perkovic, Vlado, Chalmers, John, Woodward, Mark, Li, Qiang, Cooper, Mark E, Hamet, Pavel, Harrap, Stephen, Heller, Simon, MacMahon, Stephen, Mancia, Giuseppe, Marre, Michel, Matthews, David, Neal, Bruce, Poulter, Neil, Rodgers, Anthony, Williams, Bryan, Zoungas, Sophia
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States 01.05.2016
Schlagworte:
Aged
Antihypertensive Agents - therapeutic use
Blood Glucose - metabolism
Blood Pressure - drug effects
Diabetes Mellitus, Type 2 - blood
Diabetes Mellitus, Type 2 - drug therapy
Drug Combinations
Female
Follow-Up Studies
Gliclazide - therapeutic use
Glycated Hemoglobin - metabolism
Humans
Hypoglycemia - drug therapy
Hypoglycemic Agents - therapeutic use
Indapamide - therapeutic use
Kidney Failure, Chronic - blood
Kidney Failure, Chronic - prevention & control
Male
Middle Aged
Perindopril - therapeutic use
Treatment Outcome
ISSN:1935-5548, 1935-5548
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Zusammenfassung:The Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial reported that intensive glucose control prevents end-stage kidney disease (ESKD) in patients with type 2 diabetes, but uncertainty about the balance between risks and benefits exists. Here, we examine the long-term effects of intensive glucose control on risk of ESKD and other outcomes. Survivors, previously randomized to intensive or standard glucose control, were invited to participate in post-trial follow-up. ESKD, defined as the need for dialysis or kidney transplantation, or death due to kidney disease, was documented overall and by baseline CKD stage, along with hypoglycemic episodes, major cardiovascular events, and death from other causes. A total of 8,494 ADVANCE participants were followed for a median of 5.4 additional years. In-trial HbA1c differences disappeared by the first post-trial visit. The in-trial reductions in the risk of ESKD (7 vs. 20 events, hazard ratio [HR] 0.35, P = 0.02) persisted after 9.9 years of overall follow-up (29 vs. 53 events, HR 0.54, P < 0.01). These effects were greater in earlier-stage CKD (P = 0.04) and at lower baseline systolic blood pressure levels (P = 0.01). The effects of glucose lowering on the risks of death, cardiovascular death, or major cardiovascular events did not differ by levels of kidney function (P > 0.26). Intensive glucose control was associated with a long-term reduction in ESKD, without evidence of any increased risk of cardiovascular events or death. These benefits were greater with preserved kidney function and with well-controlled blood pressure.
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ISSN:1935-5548
1935-5548
DOI:10.2337/dc15-2322