The ADVANCE Collaborative Group (2008) Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 358: 2560–2572

The majority of patients with diabetes mellitus eventually experience disabling or lethal vascular complications. Blood glucose levels and the percentage of glycated hemoglobin (HbA1c) correlate with risk of vascular events, so current guidelines for the management of patients with diabetes recommend a target HbA1c level of ≤7.0%.

Vascular outcomes have been studied in 11,140 patients with type 2 diabetes and a mean HbA1c level of 7.5% at enrollment. These patients were randomly assigned to undergo either standard therapy, which used conventional targets for glycemic control, or an intensive therapeutic regimen that involved modified-release gliclazide (30–120 mg per day) and other drugs as required to achieve ≤6.5% HbA1c. At the end of follow-up (median duration 5 years), the mean HbA1 level and mean systolic blood pressure were 7.3% and 137.9 mmHg in the standard-therapy group, compared with 6.5% and 135.5 mmHg in the intensive-therapy group, respectively. Compared with standard glycemic control, the intensive strategy was associated with a significantly lower incidence of major microvascular events. However, rates of major macrovascular events, deaths from cardiovascular causes and deaths from any cause were comparable in both groups. Unfortunately, a trend towards more hospitalizations was evident in the intensive-therapy group, partly because severe hypoglycemia occurred significantly more frequently in the intensive-control group than the in the standard-control group.

The authors conclude that an intensive therapeutic regimen for glucose control is important for prevention of microvascular complications in patients with type 2 diabetes.