Intensive Glucose Lowering Cuts Vascular Risks for Diabetic Patients, Regardless of Age or Duration: ADVANCE Trial

The trial, involving over 11,000 participants, demonstrated that intensive glucose lowering significantly reduced the risk of major vascular events, including both macrovascular and microvascular complications. Also, there were no significant differences in treatment effects based on age or the length of diabetes duration.

Diabetes remains one of the leading global health challenges, contributing to a range of serious complications, including cardiovascular disease, kidney damage, and vision loss. Effective blood sugar control is a cornerstone of diabetes management. However, the optimal approach has long been debated, particularly regarding how factors like age at diagnosis and the duration of diabetes impact treatment outcomes. Considering this, Toshiaki Ohkuma, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia, and colleagues aimed to compare the impact of intensive versus standard glucose lowering on vascular outcomes in patients with varying ages at diabetes diagnosis and different durations of diabetes.

For this purpose, the researchers analyzed data from 11,138 participants in the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial. Participants were grouped into subcategories based on age at diabetes diagnosis (≤50, >50–60, and >60 years) and the duration of their diabetes (≤5, >5–10, and >10 years).

The study revealed the following findings:

• Intensive glucose lowering significantly reduced the risk of the primary composite outcome of major macrovascular and microvascular events (hazard ratio 0.90).
• There was no evidence of differences in treatment effects across subgroups based on age at diagnosis or diabetes duration.
• Similar consistent reductions were observed for all-cause death and cardiovascular death.
• The beneficial effects were also evident across individual components of major vascular events.

The findings suggest that intensive blood sugar management leads to a significant reduction in the risk of serious vascular complications, offering crucial insights for healthcare providers and diabetic patients alike. Notably, the reduction in risks was consistent regardless of whether patients were newly diagnosed or had been living with diabetes for years, and there was no notable difference in outcomes based on the age at diagnosis or the duration of diabetes.

"The ADVANCE trial’s findings signal a shift toward a more inclusive, evidence-based approach to glucose management, emphasizing its benefits across all ages and stages of diabetes. These insights provide a critical tool for healthcare professionals working to improve long-term patient outcomes," the researchers concluded.

Reference:

Toshiaki Ohkuma, Katie Harris, Mark Woodward, Pavel Hamet, Stephen Harrap, Giuseppe Mancia, Michel Marre, Neil Poulter, John Chalmers, Sophia Zoungas, ADVANCE Collaborative Group; Intensive Glucose Lowering and Its Effects on Vascular Events and Death According to Age at Diagnosis and Duration of Diabetes: The ADVANCE Trial. Diabetes Care 2024; dc241516. https://doi.org/10.2337/dc24-1516