Long-term benefits of intensive glucose Control for preventing end-stage kidney disease: ADVANCE-ON

Muh Geot Wong, Vlado Perkovic, John Chalmers, Mark Woodward, Qiang Li, Mark E. Cooper, Pavel Hamet, Stephen Harrap, Simon Heller, Stephen Macmahon, Giuseppe Mancia, Michel Marre, David Matthews, Bruce Neal, Neil Poulter, Anthony Rodgers, Bryan Williams, Sophia Zoungas

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: 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. RESEARCH DESIGN AND METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

Original languageEnglish (US)
Pages (from-to)694-700
Number of pages7
JournalDiabetes Care
Volume39
Issue number5
DOIs
StatePublished - May 1 2016

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Chronic Kidney Failure
Glucose
perindopril drug combination indapamide
Gliclazide
Kidney Diseases
Risk Reduction Behavior
Vascular Diseases
Hypoglycemic Agents
Kidney Transplantation
Type 2 Diabetes Mellitus
Uncertainty
Survivors
Dialysis
Cause of Death
Research Design
Blood Pressure
Kidney

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Wong, M. G., Perkovic, V., Chalmers, J., Woodward, M., Li, Q., Cooper, M. E., ... Zoungas, S. (2016). Long-term benefits of intensive glucose Control for preventing end-stage kidney disease: ADVANCE-ON. Diabetes Care, 39(5), 694-700. https://doi.org/10.2337/dc15-2322

Long-term benefits of intensive glucose Control for preventing end-stage kidney disease : ADVANCE-ON. / 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.

In: Diabetes Care, Vol. 39, No. 5, 01.05.2016, p. 694-700.

Research output: Contribution to journalArticle

Wong, MG, Perkovic, V, Chalmers, J, Woodward, M, Li, Q, Cooper, ME, Hamet, P, Harrap, S, Heller, S, Macmahon, S, Mancia, G, Marre, M, Matthews, D, Neal, B, Poulter, N, Rodgers, A, Williams, B & Zoungas, S 2016, 'Long-term benefits of intensive glucose Control for preventing end-stage kidney disease: ADVANCE-ON', Diabetes Care, vol. 39, no. 5, pp. 694-700. https://doi.org/10.2337/dc15-2322
Wong MG, Perkovic V, Chalmers J, Woodward M, Li Q, Cooper ME et al. Long-term benefits of intensive glucose Control for preventing end-stage kidney disease: ADVANCE-ON. Diabetes Care. 2016 May 1;39(5):694-700. https://doi.org/10.2337/dc15-2322
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. / Long-term benefits of intensive glucose Control for preventing end-stage kidney disease : ADVANCE-ON. In: Diabetes Care. 2016 ; Vol. 39, No. 5. pp. 694-700.
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AU - Wong, Muh Geot

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AU - Woodward, Mark

AU - Li, Qiang

AU - Cooper, Mark E.

AU - Hamet, Pavel

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AU - Heller, Simon

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AU - Williams, Bryan

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N2 - OBJECTIVE: 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. RESEARCH DESIGN AND METHODS: 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. RESULTS: 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). CONCLUSIONS: 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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