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

doi:10.1111/dom.12238

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

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11 Scopus citations

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 language	English (US)
Pages (from-to)	426-432
Number of pages	7
Journal	Diabetes, Obesity and Metabolism
Volume	16
Issue number	5
DOIs	https://doi.org/10.1111/dom.12238
State	Published - May 2014
Externally published	Yes

Keywords

Glycaemic control
HbA1c
Therapy
Treatment intensification
Type 2 diabetes

ASJC Scopus subject areas

Internal Medicine
Endocrinology, Diabetes and Metabolism
Endocrinology

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10.1111/dom.12238

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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, 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

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

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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.",

keywords = "Glycaemic control, HbA1c, Therapy, Treatment intensification, Type 2 diabetes",

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

year = "2014",

month = may,

doi = "10.1111/dom.12238",

language = "English (US)",

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AU - van Dieren, S.

AU - Kengne, A. P.

AU - Chalmers, J.

AU - Beulens, J. W.J.

AU - Davis, T. M.E.

AU - Fulcher, G.

AU - Heller, S. R.

AU - Patel, A.

AU - Colagiuri, S.

AU - Hamet, P.

AU - Mancia, G.

AU - Marre, M.

AU - Neal, B.

AU - Williams, B.

AU - Peelen, L. M.

AU - van der Schouw, Y. T.

AU - Woodward, M.

AU - Zoungas, Sophia

PY - 2014/5

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N2 - 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.

AB - 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.

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KW - HbA1c

KW - Therapy

KW - Treatment intensification

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

Abstract

Keywords

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