Long-term Benefits of Intensive Glucose Control for Preventing End-Stage Kidney Disease: ADVANCE-ON

Abstract

OBJECTIVE The Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial reported that intensive glucose control prevents end-stage kidney disease (ESKD) in patients with type 2 diabetes, but uncertainty about the balance between risks and benefits exists. Here, we examine the long-term effects of intensive glucose control on risk of ESKD and other outcomes. RESEARCH DESIGN AND METHODS Survivors, previously randomized to intensive or standard glucose control, were invited to participate in post-trial follow-up. ESKD, defined as the need for dialysis or kidney transplantation, or death due to kidney disease, was documented overall and by baseline CKD stage, along with hypoglycemic episodes, major cardiovascular events, and death from other causes. RESULTS A total of 8,494 ADVANCE participants were followed for a median of 5.4 additional years. In-trial HbA1c differences disappeared by the first post-trial visit. The in-trial reductions in the risk of ESKD (7 vs. 20 events, hazard ratio [HR] 0.35, P = 0.02) persisted after 9.9 years of overall follow-up (29 vs. 53 events, HR 0.54, P < 0.01). These effects were greater in earlier-stage CKD (P = 0.04) and at lower baseline systolic blood pressure levels (P = 0.01). The effects of glucose lowering on the risks of death, cardiovascular death, or major cardiovascular events did not differ by levels of kidney function (P > 0.26). CONCLUSIONS Intensive glucose control was associated with a long-term reduction in ESKD, without evidence of any increased risk of cardiovascular events or death. These benefits were greater with preserved kidney function and with well-controlled blood pressure.

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Affiliated Institutions

• IRCCS Istituto Auxologico Italiano IT
• Université Paris Cité FR
• The University of Melbourne AU
• The George Institute for Global Health AU
• The George Institute for Global Health GB
• University of Milano-Bicocca IT
• Oxford Centre for Diabetes, Endocrinology and Metabolism GB
• Monash University AU
• University College London GB
• Centre Hospitalier de l’Université de Montréal CA
• Hôpital Bichat-Claude-Bernard FR
• Imperial College London GB
• The Royal Melbourne Hospital AU
• Istituti di Ricovero e Cura a Carattere Scientifico IT
• Baker Heart and Diabetes Institute AU
• The University of Sydney AU
• University of Oxford GB
• Johns Hopkins University US
• National Health Service GB
• University of Sheffield GB
• Université Claude Bernard Lyon 1 FR

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