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

Abstract

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.

Advance

“…The ADVANCE trial began to recruit nearly 20 years ago 1 and it is apposite to review the trial results in the light of the history and progress made in therapeutics in the treatment of type 2 diabetes since the main results were published in 2008. 2 In this series of articles in this supplement, Zoungas, Knudsen & Cooper, Chalmers & Woodward, and Marre outline the history and the findings on the ADVANCE trial in some detail, covering explicitly the lessons learned about glycaemic control, 3 renal disease, 4 observational studies, 5 and blood pressure (BP) control. 6 Long-term outcome trials are expensive and labour-intensive.…”

“…In this series of articles in this supplement, Zoungas, Knudsen & Cooper, Chalmers & Woodward, and Marre outline the history and the findings on the ADVANCE trial in some detail, covering explicitly the lessons learned about glycaemic control, renal disease, observational studies, and blood pressure (BP) control …”