Combining intensive blood sugar control with intensive blood pressure lowering can reduce the risk of death from heart disease by nearly one quarter in patients with type 2 diabetes, according to data presented Monday at the European Association for the Study of Diabetes (EASD) congress in Rome.
These latest findings from ADVANCE (Action in Diabetes and Vascular Disease), the largest trial performed in patients with type 2 diabetes, provide further evidence for a new therapeutic strategy.
The new ADVANCE results show that the benefits of tight blood glucose control, based on gliclazide modified release (Diamicron MR), and blood pressure lowering, based on a fixed combination of perindopril and indapamide (Preterax), are both independent and fully additive, reducing both the likelihood of developing and dying from the complications of diabetes.
The latest combined findings follow the recent publication of the results from the glucose lowering arm of the study in June 12 issue of the New England Journal of Medicine. The results showed that an intensive strategy, including first systematically prescribing the sulfonylurea gliclazide modified release, up to the maximal dose of four tablets per day, and then progressively other conventional drugs, lowers blood glucose levels safely to hemoglobin A1c levels of 6.5 percent and protects patients against the serious complications of diabetes.
In particular, ADVANCE researchers said that the intensive strategy reduced the risk of kidney disease by one-fifth, and reduced the risk of proteinuria, a potent predictor of increased cardiovascular risk, by nearly one third.
The intensive strategy based on modified release gliclazide provided all the benefits with a low risk of hypoglycemia (four times less compared to previous studies) and no weight gain in contrast with other therapeutic strategies based on early and higher use of insulin as well as glitazones, as shown in ACCORD.
The presenters said that it is clear that the prevention of the serious complications of diabetes requires multi-factorial intervention, since the new ADVANCE results show that the benefits of intensive blood glucose and blood pressure lowering are independent and fully additive in reducing cardiovascular death (-24 percent) and renal complications (-33 percent).
Diamicron MR and Preterax are both produced and marketed by Servier.