BP and glucose control benefits are additive

Routine blood pressure management and intensive glucose control in type 2 diabetes are independent of one another and result in substantial reductions in major renal events and all-cause mortality, Australian researchers report. The latest analysis of the ADVANCE study, which followed more than 11,000 people with type 2 diabetes for over four years, found that the combined effect of routine blood pressure management and intensive glucose control was at least as great as the effect of either treatment alone for all clinical outcomes, and appeared greater for some. Writing in Diabetes Care, the study’s authors from the George Institute For International Health in Sydney and Monash University in Melbourne said their findings contradicted recent studies suggesting an increased risk of mortality with intensive glucose control in some patients. “These findings 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,” they said. Compared to standard glucose control and placebo, the combined treatment reduced the risk of all renal events by 28% (p<0.0001), which included a 33% reduction in the risk of new or worsening nephropathy, a 54% reduction in the risk of new onset macroalbuminuria and a 25% reduction in the risk of new onset microalbuminuria. The combined treatment also reduced the risk of death by 18% (p=0.04), and cardiovascular death by 24%. The risk of microvascular events was reduced by 19% (p=0.02) but there was no significant effect on macrovascular events. “Our results indicate that intensive glucose control can be implemented safely through a conventional approach, using the gliclazide-MR based regimen and stepwise increase in oral agents, and eventually basal insulin,” the authors concluded. Diabetes Care; published online ahead of print....