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ADA: Intensive Glucose Control Reduces Complications

In diabetics, lowering mean A1C to 6.5 percent dramatically reduces risk of kidney disease

MONDAY, June 9 (HealthDay News) -- In type 2 diabetics, intensive glucose control significantly reduces the risk of serious complications, especially kidney disease, according to research presented this week at the American Diabetes Association's 68th Annual Scientific Sessions in San Francisco, and published in the June 12 issue of the New England Journal of Medicine.

Anushka Patel, M.D., of the George Institute for International Health and University of Sydney in Sydney, Australia, and colleagues from the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation) trial randomly assigned 11,140 patients at 215 centers in 20 countries to receive either standard glucose control or intensive glucose control with modified-release gliclazide and then up to three oral agents followed by insulin.

After a median follow-up of five years, the researchers found that the mean glycated hemoglobin level was lower in the intensive control group than in the standard control group (6.5 percent versus 7.3 percent). They also found intensive control reduced the combined risk of major macrovascular and microvascular complications by 10 percent, microvascular risk by 14 percent, and the risk of the development or progression of kidney disease by 21 percent. The investigators also found that intensive control was not associated with an increased risk of death or a significantly decreased risk of major macrovascular events: heart attack, stroke and death from cardiovascular disease.

"This result does not diminish the importance of the trial, since negative findings are still vitally important in the assessment of the association between glycemic targets and cardiovascular disease," states the author of an accompanying editorial. "However, by virtue of the significant reduction in nephropathy, the ADVANCE trial extended our understanding of intensive glycemic control on microvascular events in patients with type 2 diabetes."

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