scholarly journals The Impact of Frailty on the Effectiveness and Safety of Intensive Glucose Control and Blood Pressure-Lowering Therapy for People With Type 2 Diabetes: Results From the ADVANCE Trial

2021 ◽  
Author(s):  
Tu N Nguyen ◽  
Katie Harris ◽  
Mark Woodward ◽  
John Chalmers ◽  
Mark Cooper ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Glucose Control ◽  
Severe Hypoglycaemia ◽  
Intensive Glucose Control ◽  
Vascular Events ◽  
Significant Difference ◽  
Secondary Outcomes ◽  
The Impact

<b>Objective. </b>To develop a frailty index (FI) and explore the relationship of frailty to subsequent adverse outcomes on the effectiveness and safety of more intensive control of both blood glucose and blood pressure (BP), amongst participants with type-2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. <p><b>Research Design and Methods. </b>Cox proportional-hazard models were used to estimate the effectiveness and safety of intensive glucose control and BP intervention according to frailty (defined as FI>0.21) status. The primary outcomes were macrovascular events and microvascular events. The secondary outcomes were all-cause mortality, cardiovascular mortality, severe hypoglycaemia, and discontinuation of BP treatment due to hypotension/dizziness.</p> <p><b>Results.</b> There were 11140 participants (mean age 65.8, 42.5% female, 25.7% frail). Frailty was an independent predictor of all primary outcomes and secondary outcomes. The effect of intensive glucose treatment on primary outcomes showed some evidence of attenuation in the frail: HRs for combined major macro- and micro-vascular events 1.03, 95%CI 0.90-1.19 in the frail vs 0.84, 95%CI 0.74-0.94 non-frail (p=0.02). A similar trend was observed with BP intervention. <a>Severe hypoglycaemia rates (per 1000 person-years) were higher in the frail: 8.39 (6.15–10.63) vs. 4.80 (3.84–5.76) in non-frail</a> (p<0.001). There was no significant difference in discontinuation of BP treatment between frailty groups.</p> <p><b>Conclusions. </b>It was possible to retrospectively estimate frailty in a trial population, and this FI identified those at higher risk of poor outcomes. Participants with frailty had some attenuation of benefit from intensive glucose lowering and BP lowering treatments. </p>

scholarly journals The Impact of Frailty on the Effectiveness and Safety of Intensive Glucose Control and Blood Pressure-Lowering Therapy for People With Type 2 Diabetes: Results From the ADVANCE Trial

2021 ◽  
Author(s):  
Tu N Nguyen ◽  
Katie Harris ◽  
Mark Woodward ◽  
John Chalmers ◽  
Mark Cooper ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Glucose Control ◽  
Severe Hypoglycaemia ◽  
Intensive Glucose Control ◽  
Vascular Events ◽  
Significant Difference ◽  
Secondary Outcomes ◽  
The Impact

<b>Objective. </b>To develop a frailty index (FI) and explore the relationship of frailty to subsequent adverse outcomes on the effectiveness and safety of more intensive control of both blood glucose and blood pressure (BP), amongst participants with type-2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. <p><b>Research Design and Methods. </b>Cox proportional-hazard models were used to estimate the effectiveness and safety of intensive glucose control and BP intervention according to frailty (defined as FI>0.21) status. The primary outcomes were macrovascular events and microvascular events. The secondary outcomes were all-cause mortality, cardiovascular mortality, severe hypoglycaemia, and discontinuation of BP treatment due to hypotension/dizziness.</p> <p><b>Results.</b> There were 11140 participants (mean age 65.8, 42.5% female, 25.7% frail). Frailty was an independent predictor of all primary outcomes and secondary outcomes. The effect of intensive glucose treatment on primary outcomes showed some evidence of attenuation in the frail: HRs for combined major macro- and micro-vascular events 1.03, 95%CI 0.90-1.19 in the frail vs 0.84, 95%CI 0.74-0.94 non-frail (p=0.02). A similar trend was observed with BP intervention. <a>Severe hypoglycaemia rates (per 1000 person-years) were higher in the frail: 8.39 (6.15–10.63) vs. 4.80 (3.84–5.76) in non-frail</a> (p<0.001). There was no significant difference in discontinuation of BP treatment between frailty groups.</p> <p><b>Conclusions. </b>It was possible to retrospectively estimate frailty in a trial population, and this FI identified those at higher risk of poor outcomes. Participants with frailty had some attenuation of benefit from intensive glucose lowering and BP lowering treatments. </p>

Cardiovascular Risk in Type 2 Diabetes – Reflecting on the ADVANCE Study

2009 ◽  
Vol 05 (0) ◽  
pp. 42
Author(s):  
Sophia Zoungas ◽  
John Chalmers ◽  
Anushka Patel ◽  
◽  
◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Cardiovascular Risk ◽  
Vascular Disease ◽  
Large Scale ◽  
Intensive Glucose Control ◽  
Vascular Events ◽  
Advance Study ◽  
High Blood Glucose

The world is facing an unprecedented increase in type 2 diabetes. Most disability and premature mortality experienced by patients with diabetes is related to vascular disease and, in particular, macrovascular disease (such as coronary heart disease and stroke) and microvascular disease (such as retinopathy, nephropathy and neuropathy). Indeed, around 1.9 million cardiovascular deaths worldwide are attributable to high blood glucose levels and diabetes, as well as to their associated dangerous companions of high blood pressure and abnormal lipid levels. The global economic costs of diabetes, including foregone economic growth and increasing healthcare expenditure, are substantial and are anticipated to grow. Therefore, strategies to reduce disease burden have continued to focus on reducing cardiovascular risk. Recently, a number of large-scale clinical trials have evaluated approaches for managing cardiovascular risk in patients with type 2 diabetes. Among them the Action in Diabetes and Vascular Disease: PreterAx and DiamicroN MR Controlled Evaluation (ADVANCE) trial has reported the effects of blood pressure lowering and intensive glucose control on major vascular events in patients with established type 2 diabetes. In this article we summarise the findings of the ADVANCE trial and discuss its relevance to the management of cardiovascular risk in patients with type 2 diabetes worldwide.

Cardiovascular Risk in Type 2 Diabetes – Reflecting on the ADVANCE Study

2009 ◽  
Vol 05 (01) ◽  
pp. 42
Author(s):  
Sophia Zoungas ◽  
John Chalmers ◽  
Anushka Patel ◽  
◽  
◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Cardiovascular Risk ◽  
Vascular Disease ◽  
Large Scale ◽  
Intensive Glucose Control ◽  
Vascular Events ◽  
Advance Study ◽  
High Blood Glucose

The world is facing an unprecedented increase in type 2 diabetes. Most disability and premature mortality experienced by patients with diabetes is related to vascular disease and, in particular, macrovascular disease (such as coronary heart disease and stroke) and microvascular disease (such as retinopathy, nephropathy and neuropathy). Indeed, around 1.9 million cardiovascular deaths worldwide are attributable to high blood glucose levels and diabetes, as well as to their associated dangerous companions of high blood pressure and abnormal lipid levels. The global economic costs of diabetes, including foregone economic growth and increasing healthcare expenditure, are substantial and are anticipated to grow. Therefore, strategies to reduce disease burden have continued to focus on reducing cardiovascular risk. Recently, a number of large-scale clinical trials have evaluated approaches for managing cardiovascular risk in patients with type 2 diabetes. Among them the Action in Diabetes and Vascular Disease: PreterAx and DiamicroN MR Controlled Evaluation (ADVANCE) trial has reported the effects of blood pressure lowering and intensive glucose control on major vascular events in patients with established type 2 diabetes. In this article we summarise the findings of the ADVANCE trial and discuss its relevance to the management of cardiovascular risk in patients with type 2 diabetes worldwide.

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