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- Title
Effects of Intensive Glycemic Control on Clinical Outcomes Among Patients With Type 2 Diabetes With Different Levels of Cardiovascular Risk and Hemoglobin A<sub>1c</sub> in the ADVANCE Trial.
- Authors
Jingyan Tian; Toshiaki Ohkuma; Cooper, Mark; Harrap, Stephen; Giuseppe Mancia; Poulter, Neil; Ji-Guang Wang; Zoungas, Sophia; Woodward, Mark; Chalmers, John; Tian, Jingyan; Ohkuma, Toshiaki; Mancia, Giuseppe; Wang, Ji-Guang
- Abstract
<bold>Objective: </bold>To study whether the effects of intensive glycemic control on major vascular outcomes (a composite of major macrovascular and major microvascular events), all-cause mortality, and severe hypoglycemia events differ among participants with different levels of 10-year risk of atherosclerotic cardiovascular disease (ASCVD) and hemoglobin A1c (HbA1c) at baseline.<bold>Research Design and Methods: </bold>We studied the effects of more intensive glycemic control in 11,071 patients with type 2 diabetes (T2D), without missing values, in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial, using Cox models.<bold>Results: </bold>During 5 years' follow-up, intensive glycemic control reduced major vascular events (hazard ratio [HR] 0.90 [95% CI 0.83-0.98]), with the major driver being a reduction in the development of macroalbuminuria. There was no evidence of differences in the effect, regardless of baseline ASCVD risk or HbA1c level (P for interaction = 0.29 and 0.94, respectively). Similarly, the beneficial effects of intensive glycemic control on all-cause mortality were not significantly different across baseline ASCVD risk (P = 0.15) or HbA1c levels (P = 0.87). The risks of severe hypoglycemic events were higher in the intensive glycemic control group compared with the standard glycemic control group (HR 1.85 [1.41-2.42]), with no significant heterogeneity across subgroups defined by ASCVD risk or HbA1c at baseline (P = 0.09 and 0.18, respectively).<bold>Conclusions: </bold>The major benefits for patients with T2D in ADVANCE did not substantially differ across levels of baseline ASCVD risk and HbA1c.
- Subjects
GLYCEMIC control; TYPE 2 diabetes; HEMOGLOBINS
- Publication
Diabetes Care, 2020, Vol 43, Issue 6, p1293
- ISSN
0149-5992
- Publication type
journal article
- DOI
10.2337/dc19-1817