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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
biochemistry, genetics and molecular biology
Intensification of medication and glycaemic control among patients with type 2 diabetes-The ADVANCE trial
Diabetes, Obesity and Metabolism, Volume 16, No. 5, Year 2014
Notification
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Description
Aims: The aim of this study was to assess associations between patient characteristics, intensification of blood glucose-lowering treatment through oral glucose-lowering therapy and/or insulin and effective glycaemic control in type 2 diabetes. Methods: 11140 patients from the Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) trial who were randomized to intensive glucose control or standard glucose control and followed up for a median of 5years were categorized into two groups: effective glycaemic control [haemoglobin A1c (HbA1c)≤7.0% or a proportionate reduction in HbA1c over 10%] or ineffective glycaemic control (HbA1c>7.0% and a proportionate reduction in HbA1c less than or equal to 10%). Therapeutic intensification was defined as addition of an oral glucose-lowering agent or commencement of insulin. Pooled logistic regression models examined the associations between patient factors, intensification and effective glycaemic control. Results: A total of 7768 patients (69.7%), including 3198 in the standard treatment group achieved effective glycaemic control. Compared to patients with ineffective control, patients with effective glycaemic control had shorter duration of diabetes and lower HbA1c at baseline and at the time of treatment intensification. Treatment intensification with addition of an oral agent or commencement of insulin was associated with a 107% [odds ratio, OR: 2.07 (95% confidence interval, CI: 1.95-2.20)] and 152% [OR: 2.52 (95% CI: 2.30-2.77)] greater chance of achieving effective glycaemic control, respectively. These associations were robust after adjustment for several baseline characteristics and not modified by the number of oral medications taken at the time of treatment intensification. Conclusions: Effective glycaemic control was associated with treatment intensification at lower HbA1c levels at all stages of the disease course and in both arms of the ADVANCE trial. © 2013 John Wiley & Sons Ltd.
Authors & Co-Authors
van Dieren, Susan
Australia, Sydney
The University of Sydney
Netherlands, Utrecht
University Medical Center Utrecht
Kengne, Andre-Pascal Pascal
Australia, Sydney
The University of Sydney
Netherlands, Utrecht
University Medical Center Utrecht
South Africa, Cape Town
University of Cape Town
Chalmers, John P.
Australia, Sydney
The University of Sydney
Beulens, J. W.J.
Netherlands, Utrecht
University Medical Center Utrecht
Davis, Timothy M.E.
Australia, Perth
University of Western Australia, School of Medicine and Pharmacology
Fulcher, Greg R.
Australia, Sydney
Royal North Shore Hospital
Heller, Simon R.
United Kingdom, Sheffield
The Sheffield Medical School
Patel, Anushka A.
Australia, Sydney
The University of Sydney
Colagiuri, Stephen
Australia, Sydney
The University of Sydney
Hamet, Pavel
Canada, Montreal
University of Montreal
Mancia, Giuseppe
Italy, Milan
Irccs Istituto Auxologico Italiano
Marre, Michel
France, Paris
Hôpital Bichat-claude-bernard Ap-hp
Neal, Bruce Charles
Australia, Sydney
The University of Sydney
Williams, Bryan Robinson
United Kingdom, Leicester
University of Leicester
Peelen, Linda Margaretha
Netherlands, Utrecht
University Medical Center Utrecht
van der Schouw, Y. T.
Netherlands, Utrecht
University Medical Center Utrecht
Woodward, Mark A.
Australia, Sydney
The University of Sydney
Zoungas, Sophia
Australia, Sydney
The University of Sydney
Australia, Clayton
Monash University
Statistics
Citations: 18
Authors: 18
Affiliations: 11
Identifiers
Doi:
10.1111/dom.12238
ISSN:
14628902
e-ISSN:
14631326
Research Areas
Health System And Policy
Noncommunicable Diseases
Study Design
Case-Control Study