New findings from ADVANCE clinical trial presented

New analyses of the largest-ever clinical trial of patients with type 2 diabetes show that the combination of blood pressure lowering treatment and intensive glucose (blood sugar) control improved patients' vascular condition and resulted in a significant 18 percent reduction in the risk of death from all causes.

The results were presented yesterday by Dr. Pavel Hamet, Chief of Gene Medicine Services at Centre hospitalier de l'Université de Montréal (CHUM) and professor of Medicine, Université de Montréal, the study's principal investigator for Canada, at the International Diabetes Federation (IDF) Congress 2009 in Montreal and published in the journal Diabetes Care.

The findings come from the ADVANCE (Action in Diabetes and Vascular Disease) trial, the largest-ever clinical trial of patients with type 2 diabetes, coordinated in Canada by the Centre hospitalier de l'Université de Montréal (CHUM).

The new results presented yesterday suggest that the overall management of patients with established type 2 diabetes should incorporate routine blood pressure lowering and more intensive glucose control with the best care available to reduce the burden of further disease complications.

"These new findings of ADVANCE provide considerable reassurance that the widely used clinical approach of joint management of blood pressure and glucose in patients with type 2 diabetes is both appropriate and effective," said Dr. Hamet. "Our findings provide further evidence for the benefits of a multi-faceted treatment approach that includes blood pressure lowering and intensive glucose control in patients with type 2 diabetes."

The face of diabetes in Canada

By 2010, more than 3 million Canadians will have diabetes and that number will continue to grow by nearly 550 every day. More than 60% of people with diabetes have high blood pressure, and almost 60% have high cholesterol. As a result, cardiovascular disease such as heart attacks and strokes is the leading cause of death in people with diabetes.

Key results

There was no interaction between the effects of the routine blood pressure lowering and intensive glucose control for any of the pre-specified clinical outcomes. When compared to neither intervention, combination treatment reduced the risk of new or worsening nephropathy by 33%, new onset macroalbuminuria by 54% and new onset microalbuminuria by 26%. Combination treatment was associated with an 18% reduction in the risk of all-cause death.

"We anticipate that the combined treatment strategy employed by ADVANCE may further reduce cardiovascular risk in the long term," said Dr. Hamet. "From the blood pressure part of the ADVANCE study we already knew that treating blood pressure with Coversyl Plus offers a vascular protection for type 2 diabetic patients. We now have an additional proof that we can have better results by combining good treatments."