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

Susan Van Dieren; Andre Kengne; John Chalmers; Joline Beulens; Timothy Davis; Greg Fulcher; S Heller; Anushka Patel; Stephen Colagiuri; Pavel Hamet; Giuseppe Mancia; Michel Marre; Bruce Neal; Bryan Williams; Linda Peelen; Yvonne Van Der Schouw; Mark Woodward; Sophia Zoungas

doi:10.1111/dom.12238

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

Susan Van Dieren, Andre Kengne, John Chalmers, Joline Beulens, Timothy Davis, Greg Fulcher, S Heller, Anushka Patel, Stephen Colagiuri, Pavel Hamet, Giuseppe Mancia, Michel Marre, Bruce Neal, Bryan Williams, Linda Peelen, Yvonne Van Der Schouw, Mark Woodward, Sophia Zoungas

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13 Citations (Scopus)

Abstract

Aims: The aim of this study was 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. Methods: 11140 patients from the Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) trial who were randomized to intensive glucose control or standard glucose control and followed up for a median of 5years were categorized into two groups: effective glycaemic control [haemoglobin A1c (HbA1c)≤7.0% or a proportionate reduction in HbA1c over 10%] or ineffective 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: A total of 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% [odds ratio, OR: 2.07 (95% confidence interval, 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.

Original language	English
Pages (from-to)	426-432
Number of pages	7
Journal	Diabetes, Obesity and Metabolism
Volume	16
Issue number	5
DOIs	https://doi.org/10.1111/dom.12238
Publication status	Published - May 2014

Keywords

Glycaemic control
HbA1c
Therapy
Treatment intensification
Type 2 diabetes

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10.1111/dom.12238

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Van Dieren, S., Kengne, A., Chalmers, J., Beulens, J., Davis, T., Fulcher, G., Heller, S., Patel, A., Colagiuri, S., Hamet, P., Mancia, G., Marre, M., Neal, B., Williams, B., Peelen, L., Van Der Schouw, Y., Woodward, M., & Zoungas, S. (2014). Intensification of medication and glycaemic control among patients with type 2 diabetes-The ADVANCE trial. Diabetes, Obesity and Metabolism, 16(5), 426-432. https://doi.org/10.1111/dom.12238

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title = "Intensification of medication and glycaemic control among patients with type 2 diabetes-The ADVANCE trial",

abstract = "Aims: The aim of this study was 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. Methods: 11140 patients from the Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) trial who were randomized to intensive glucose control or standard glucose control and followed up for a median of 5years were categorized into two groups: effective glycaemic control [haemoglobin A1c (HbA1c)≤7.0% or a proportionate reduction in HbA1c over 10%] or ineffective 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: A total of 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% [odds ratio, OR: 2.07 (95% confidence interval, 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.",

keywords = "Glycaemic control, HbA1c, Therapy, Treatment intensification, Type 2 diabetes",

author = "{Van Dieren}, Susan and Andre Kengne and John Chalmers and Joline Beulens and Timothy Davis and Greg Fulcher and S Heller and Anushka Patel and Stephen Colagiuri and Pavel Hamet and Giuseppe Mancia and Michel Marre and Bruce Neal and Bryan Williams and Linda Peelen and {Van Der Schouw}, Yvonne and Mark Woodward and Sophia Zoungas",

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doi = "10.1111/dom.12238",

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Van Dieren, S, Kengne, A, Chalmers, J, Beulens, J, Davis, T, Fulcher, G, Heller, S, Patel, A, Colagiuri, S, Hamet, P, Mancia, G, Marre, M, Neal, B, Williams, B, Peelen, L, Van Der Schouw, Y, Woodward, M & Zoungas, S 2014, 'Intensification of medication and glycaemic control among patients with type 2 diabetes-The ADVANCE trial', Diabetes, Obesity and Metabolism, vol. 16, no. 5, pp. 426-432. https://doi.org/10.1111/dom.12238

TY - JOUR

T1 - Intensification of medication and glycaemic control among patients with type 2 diabetes-The ADVANCE trial

AU - Van Dieren, Susan

AU - Kengne, Andre

AU - Chalmers, John

AU - Beulens, Joline

AU - Davis, Timothy

AU - Fulcher, Greg

AU - Heller, S

AU - Patel, Anushka

AU - Colagiuri, Stephen

AU - Hamet, Pavel

AU - Mancia, Giuseppe

AU - Marre, Michel

AU - Neal, Bruce

AU - Williams, Bryan

AU - Peelen, Linda

AU - Van Der Schouw, Yvonne

AU - Woodward, Mark

AU - Zoungas, Sophia

PY - 2014/5

Y1 - 2014/5

N2 - Aims: The aim of this study was 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. Methods: 11140 patients from the Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) trial who were randomized to intensive glucose control or standard glucose control and followed up for a median of 5years were categorized into two groups: effective glycaemic control [haemoglobin A1c (HbA1c)≤7.0% or a proportionate reduction in HbA1c over 10%] or ineffective 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: A total of 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% [odds ratio, OR: 2.07 (95% confidence interval, 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.

AB - Aims: The aim of this study was 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. Methods: 11140 patients from the Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) trial who were randomized to intensive glucose control or standard glucose control and followed up for a median of 5years were categorized into two groups: effective glycaemic control [haemoglobin A1c (HbA1c)≤7.0% or a proportionate reduction in HbA1c over 10%] or ineffective 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: A total of 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% [odds ratio, OR: 2.07 (95% confidence interval, 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.

KW - Glycaemic control

KW - HbA1c

KW - Therapy

KW - Treatment intensification

KW - Type 2 diabetes

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U2 - 10.1111/dom.12238

DO - 10.1111/dom.12238

M3 - Article

SN - 1462-8902

VL - 16

SP - 426

EP - 432

JO - Diabetes, Obesity and Metabolism

JF - Diabetes, Obesity and Metabolism

IS - 5

ER -

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

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Keywords

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