Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation - ADVANCE

The ADVANCE website

Aims

To determine the effects of more intensive blood pressure lowering and glucose control on the risks of complications in patients with type 2 diabetes.

Methods

The study was a factorial, multicentre, randomised controlled trial. 11,140 participants were recruited and randomised to either a fixed low-dose perindopril-indapamide combination or matching placebo, and to either an intensive modified-release gliclazide-based glucose lowering strategy or standard guidelines-based glucose lowering therapy.

Follow-up was for an average of 5 years. The primary outcomes were major macrovascular complications (stroke and heart attack) and major microvascular complications (eye and renal disease).

Status/Results

The blood pressure arm results were released in September 2007 - information on the results is available in our News section. The glucose arm closed in December 2007 and was presented and published in June 2008. Major sub-studies examining the eye and heart will also be reported shortly.

Substudies

ADVANCE Retinopathy Measurements (ADREM)

The aim of this sub study is to measure the incidence and progression of background retinopathy by blood pressure lowering or intensive glucose control in patients with type 2 diabetes. ADVANCE participants from Australia, Canada, China, Estonia, Germany, India, Ireland, Malaysia, Netherlands, Slovakia, and the UK were included in this substudy, and had retinal photographs obtained at baseline, 2 years and at the end of follow-up for the blood pressure arm of the study. The results of ADREM will be reported shortly.

ADVANCE Diastolic Function Echocardiography Sub-study

The aim of the sub-study is to determine whether routine blood pressure lowering and intensive glucose control will improve left ventricular diastolic function and structure (LV mass) in patients with type 2 diabetes. This is one of the largest cross-sectional echocardiographic datasets with contemporary echocardiography methods in patients with type 2 diabetes. Echocardiograms at baseline, 6 months and at the end of follow-up for the blood pressure arm of the study were performed in a subgroup of participants from Australia, Ireland, New Zealand, and the UK. The results of this substudy will be reported shortly.

Publications

Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. ADVANCE Collaborative Group - Lancet 2007; 370: 829-40.
Full text

ADVANCE Publications List July 2008

Institute Investigators

Project Managers

  • Helen Monaghan
  • Samantha Flynn

Collaboration

Funding Agencies