Renal protection: What have we learnt from ADVANCE about kidney disease in type 2 diabetes?

Area of Science:

• Cardiology
• Endocrinology
• Clinical Trials

Background:

• Type 2 diabetes poses significant risks for macrovascular and microvascular events.
• Effective management of blood pressure and glycemia is crucial for mitigating these risks.

Purpose of the Study:

• To evaluate the effects of intensive blood pressure lowering and intensive glucose control on vascular events in type 2 diabetes patients.
• To analyze long-term outcomes and biomarker data from the ADVANCE trial.

Main Methods:

• A factorial randomized controlled trial involving 11,140 type 2 diabetic patients.
• Interventions included a fixed perindopril/indapamide combination for blood pressure and gliclazide-based glucose lowering.
• Primary endpoints were major macrovascular and microvascular events.

Main Results:

• Intensive blood pressure lowering significantly reduced the risk of major macrovascular and microvascular events.
• Intensive glucose control did not significantly reduce major macro- or microvascular events but reduced renal events.
• Observational follow-up and biomarker studies provided further insights into treatment effects.

Conclusions:

• Treating hypertension with perindopril/indapamide in type 2 diabetes is beneficial for vascular outcomes.
• Intensive glucose control to HbA1c ≤6.5% did not show overall macro/microvascular benefit but reduced renal events.
• The ADVANCE data inform current treatment strategies for managing vascular complications in type 2 diabetes.