title: Intensification of medication and glycaemic control among patients with type 2 diabetes - the ADVANCE trial.
abstract: OBJECTIVE
  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
  11 140 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 5 years 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.
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: van Dieren
authors.forename: A P
authors.initials: AP
authors.lastname: Kengne
authors.forename: J
authors.initials: J
authors.lastname: Chalmers
authors.forename: J W J
authors.initials: JW
authors.lastname: Beulens
authors.forename: T M E
authors.initials: TM
authors.lastname: Davis
authors.forename: G
authors.initials: G
authors.lastname: Fulcher
authors.forename: S R
authors.initials: SR
authors.lastname: Heller
authors.forename: A
authors.initials: A
authors.lastname: Patel
authors.forename: S
authors.initials: S
authors.lastname: Colagiuri
authors.forename: P
authors.initials: P
authors.lastname: Hamet
authors.forename: G
authors.initials: G
authors.lastname: Mancia
authors.forename: M
authors.initials: M
authors.lastname: Marre
authors.forename: B
authors.initials: B
authors.lastname: Neal
authors.forename: B
authors.initials: B
authors.lastname: Williams
authors.forename: L M
authors.initials: LM
authors.lastname: Peelen
authors.forename: Y T
authors.initials: YT
authors.lastname: van der Schouw
authors.forename: M
authors.initials: M
authors.lastname: Woodward
authors.forename: S
authors.initials: S
authors.lastname: Zoungas
mesh_terms: D000284:Administration, Oral; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000187:drug effects* / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human
keywords: HbA1c; glycaemic control; therapy; treatment intensification; type 2 diabetes