Intensification of medication and glycaemic control among patients with type 2 diabetes-The ADVANCE trial

S. van Dieren, A. P. Kengne, J. Chalmers, J. W J Beulens, T. M E Davis, G. Fulcher, S. R. Heller, A. Patel, S. Colagiuri, P. Hamet, G. Mancia, M. Marre, B. Neal, B. Williams, L. M. Peelen, Y. T. van der Schouw, M. Woodward, Sophia Zoungas

Research output: Contribution to journalArticle

Abstract

Aims: The aim of this study was to assess associations between patient characteristics, intensification of blood glucose-lowering treatment through oral glucose-lowering therapy and/or insulin and effective glycaemic control in type 2 diabetes. Methods: 11140 patients from the Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) trial who were randomized to intensive glucose control or standard glucose control and followed up for a median of 5years were categorized into two groups: effective glycaemic control [haemoglobin A1c (HbA1c)≤7.0% or a proportionate reduction in HbA1c over 10%] or ineffective glycaemic control (HbA1c>7.0% and a proportionate reduction in HbA1c less than or equal to 10%). Therapeutic intensification was defined as addition of an oral glucose-lowering agent or commencement of insulin. Pooled logistic regression models examined the associations between patient factors, intensification and effective glycaemic control. Results: A total of 7768 patients (69.7%), including 3198 in the standard treatment group achieved effective glycaemic control. Compared to patients with ineffective control, patients with effective glycaemic control had shorter duration of diabetes and lower HbA1c at baseline and at the time of treatment intensification. Treatment intensification with addition of an oral agent or commencement of insulin was associated with a 107% [odds ratio, OR: 2.07 (95% confidence interval, CI: 1.95-2.20)] and 152% [OR: 2.52 (95% CI: 2.30-2.77)] greater chance of achieving effective glycaemic control, respectively. These associations were robust after adjustment for several baseline characteristics and not modified by the number of oral medications taken at the time of treatment intensification. Conclusions: Effective glycaemic control was associated with treatment intensification at lower HbA1c levels at all stages of the disease course and in both arms of the ADVANCE trial.

Original languageEnglish (US)
Pages (from-to)426-432
Number of pages7
JournalDiabetes, Obesity and Metabolism
Volume16
Issue number5
DOIs
StatePublished - 2014
Externally publishedYes

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Type 2 Diabetes Mellitus
Hemoglobins
Glucose
perindopril drug combination indapamide
Therapeutics
Insulin
Logistic Models
Gliclazide
Vascular Diseases
Blood Glucose
Odds Ratio
Confidence Intervals

Keywords

  • Glycaemic control
  • HbA1c
  • Therapy
  • Treatment intensification
  • Type 2 diabetes

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Medicine(all)

Cite this

van Dieren, S., Kengne, A. P., Chalmers, J., Beulens, J. W. J., Davis, T. M. E., Fulcher, G., ... Zoungas, S. (2014). Intensification of medication and glycaemic control among patients with type 2 diabetes-The ADVANCE trial. Diabetes, Obesity and Metabolism, 16(5), 426-432. https://doi.org/10.1111/dom.12238

Intensification of medication and glycaemic control among patients with type 2 diabetes-The ADVANCE trial. / van Dieren, S.; Kengne, A. P.; Chalmers, J.; Beulens, J. W J; Davis, T. M E; Fulcher, G.; Heller, S. R.; Patel, A.; Colagiuri, S.; Hamet, P.; Mancia, G.; Marre, M.; Neal, B.; Williams, B.; Peelen, L. M.; van der Schouw, Y. T.; Woodward, M.; Zoungas, Sophia.

In: Diabetes, Obesity and Metabolism, Vol. 16, No. 5, 2014, p. 426-432.

Research output: Contribution to journalArticle

van Dieren, S, Kengne, AP, Chalmers, J, Beulens, JWJ, Davis, TME, Fulcher, G, Heller, SR, Patel, A, Colagiuri, S, Hamet, P, Mancia, G, Marre, M, Neal, B, Williams, B, Peelen, LM, van der Schouw, YT, Woodward, M & Zoungas, S 2014, 'Intensification of medication and glycaemic control among patients with type 2 diabetes-The ADVANCE trial', Diabetes, Obesity and Metabolism, vol. 16, no. 5, pp. 426-432. https://doi.org/10.1111/dom.12238
van Dieren, S. ; Kengne, A. P. ; Chalmers, J. ; Beulens, J. W J ; Davis, T. M E ; Fulcher, G. ; Heller, S. R. ; Patel, A. ; Colagiuri, S. ; Hamet, P. ; Mancia, G. ; Marre, M. ; Neal, B. ; Williams, B. ; Peelen, L. M. ; van der Schouw, Y. T. ; Woodward, M. ; Zoungas, Sophia. / Intensification of medication and glycaemic control among patients with type 2 diabetes-The ADVANCE trial. In: Diabetes, Obesity and Metabolism. 2014 ; Vol. 16, No. 5. pp. 426-432.
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