Renal protection: What have we learnt from ADVANCE about kidney disease in type 2 diabetes?

• Published in: Diabetes, obesity & metabolism Vol. 22; no. S2; pp. 12 - 18
• Main Authors: Knudsen, Søren T., Cooper, Mark E.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.04.2020; Wiley Subscription Services, Inc
• Subjects: antidiabetic drug; Antidiabetics; Blood pressure; cardiovascular disease; clinical trial; Clinical trials; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetic nephropathy; Diuretics; Drug delivery; Glucose; glycaemic control; Hemoglobin; Indapamide; Kidney diseases; macrovascular disease; Medical treatment; Microvasculature; Patients; Vascular diseases; clinical trial; antidiabetic drug; cardiovascular disease; glycaemic control; macrovascular disease; diabetic nephropathy
• ISSN: 1462-8902; 1463-1326
• DOI: 10.1111/dom.13917

The Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) factorial trial was a landmark randomized controlled clinical trial in 11 140 type 2 diabetic patients from 215 centers in 20 countries with a two‐by‐two factorial design. In the blood pressure‐lowering arm, patients were treated using a fixed combination of the ACE‐inhibitor, perindopril, and the thiazide‐like diuretic, indapamide, or placebo, whereas in the glucose‐lowering arm, the intervention compared the sulphonylurea gliclazide plus other glucose‐lowering drugs, targeting a glycated hemoglobin value of 6.5% or less, with standard glucose control. Primary end‐points were major macro‐ and microvascular events in both arms. This review gives an overview of the results of the primary randomized trial, results from observational follow‐up studies, and results of several biomarker studies and discusses the perspectives of these data in the context of recent major outcome trials for current medical treatment.