The George Institute For Global Health
United Kingdom

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

TitleIntensification of medication and glycaemic control among patients with type 2 diabetes - the ADVANCE trial
Publication TypeJournal Article
Year of Publication2013
Authorsvan Dieren, S, Kengne, A, Chalmers, J, Beulens, JW, Davis, T, Fulcher, G, Heller, SR, Patel, A, Colagiuri, S, Hamet, P, Mancia, G, Marre, M, Neal, B, Williams, B, Peelen, L, van der Schouw, Y, Woodward, M, Zoungas, S
JournalDiabetes, Obesity and Metabolism
Date Published11/2013
ISBN Number1463-1326 (Electronic) - 1462-8902 (Linking)
Accession Number24251579

AIMS: 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. MATERIALS AND METHODS: 11,140 patients from the ADVANCE trial who were randomised to intensive glucose control or standard glucose control and followed for a median of 5 years were categorised into 2 groups: effective 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: 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% (OR: 2.07 [95% 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.