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ADVANCE: breaking new ground in type 2 diabetes
John Chalmers1, Vlado Perkovic, Rohina Joshi
1The George Institute for International Health, The University of Sydney and The Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Summary
The ADVANCE trial investigated blood pressure lowering and intensive glucose control in type 2 diabetes. Both interventions were found to be safe and well-tolerated, with completion expected in 2007.
Area of Science:
- Cardiology
- Endocrinology
- Clinical Trials
Background:
- Type 2 diabetes is associated with increased risks of vascular disease.
- Optimal management strategies for blood pressure and glucose control in type 2 diabetes remain under investigation.
- The ADVANCE trial addresses key questions regarding the benefits of these interventions.
Purpose of the Study:
- To evaluate the efficacy of blood pressure lowering therapy in reducing major vascular disease risk.
- To assess the impact of intensive glucose control on microvascular disease.
- To determine if the benefits of blood pressure and glucose lowering are additive.
Main Methods:
- A 2x2 factorial randomized clinical trial design.
- Investigated perindopril/indapamide combination versus placebo for blood pressure control.
- Evaluated intensive gliclazide-MR-based glucose control versus standard therapy.
- Primary outcomes included composite macrovascular and microvascular endpoints.
Main Results:
- 11,140 patients with type 2 diabetes were randomized.
- The fixed-dose combination of perindopril and indapamide was safe and effective in lowering blood pressure during the run-in phase.
- Study medications have been well tolerated.
- Study completion is scheduled for 2007.
Conclusions:
- The fixed low-dose combination of perindopril and indapamide is safe and effective for blood pressure lowering in type 2 diabetes.
- Post-randomization treatments in the ADVANCE trial have been well tolerated.
- Further results on vascular outcomes are anticipated upon study completion.
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