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ADVANCE in context: The benefits, risks and feasibility of providing intensive glycaemic control based on gliclazide

Sophia Zoungas1,2

  • 1School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.

Diabetes, Obesity & Metabolism
|April 7, 2020
PubMed

Insights

Four major trials, including the ADVANCE study, examined intensive glucose control in type 2 diabetes. This review compares the ADVANCE trial

Area of Science:

  • Endocrinology
  • Cardiovascular Medicine
  • Diabetes Research

Background:

  • International guidelines recommend HbA1c targets of 6.5% or less for type 2 diabetes patients to prevent complications.
  • Four large multicenter randomized clinical trials (UKPDS, ADVANCE, ACCORD, VADT) have investigated intensive glucose control strategies over the past 30 years.

Purpose of the Study:

  • To review and compare the glucose-lowering approach used in the ADVANCE trial with those employed in other major glycaemic control studies.
  • To provide critical insights into the benefits and risks of intensive versus standard glucose control in type 2 diabetes.

Main Methods:

  • Comparative review of four major randomized clinical trials: UKPDS, ADVANCE, ACCORD, and VADT.
  • Analysis of glucose-lowering strategies and their impact on vascular outcomes.

Main Results:

  • The trials collectively offer robust evidence on the vascular benefits and risks associated with different glucose control intensities.
  • Insights into the practical application and outcomes of various therapeutic approaches.

Conclusions:

  • Understanding the nuances of glucose-lowering strategies is crucial for optimizing patient care in type 2 diabetes.
  • The ADVANCE trial's approach provides a valuable point of comparison for evaluating intensive glycaemic control in diabetes management.
Keywords:
antidiabetic drugcardiovascular diseasediabetes complicationsglycaemic controlsulphonylureas

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