T2DM treatment ADVANCE comes with caveats

At the 68^th Scientific Sessions of the American Diabetes Association (ADA) [San Francisco, California, US, June 2008], results of the glucose-lowering component of the ADVANCE study were presented. In this, the largest ever study of treatments in diabetes, more than 11 000 diabetic patients from around the world were randomised to receive standard or intensive glucose-lowering therapy in an attempt to determine whether HbA1c levels could be safely lowered to 6.5%. Importantly, the ADVANCE study revealed a 21% reduction in risk of kidney disease with this intensive glucose-lowering strategy. However, while there was no reduction in the primary endpoint, a combination of macro- and microvascular endpoints, there was no evidence of any increase in macrovascular events with the intensive glucose-lowering strategy, indicating that treatment to this HbA1c target is well tolerated. Importantly, ADVANCE showed that with therapies available today across the world it is possible to achieve and maintain very tight levels of glucose control.