TY - JOUR
T1 - The comparative effects of intensive glucose lowering in diabetes patients aged below or above 65 years
T2 - Results from the ADVANCE trial
AU - Ohkuma, Toshiaki
AU - Chalmers, John
AU - Cooper, Mark
AU - Hamet, Pavel
AU - Harrap, Stephen
AU - Marre, Michel
AU - Mancia, Giuseppe
AU - Poulter, Neil
AU - Woodward, Mark
N1 - Funding Information:
The ADVANCE trial was funded by grants from the National Health and Medical Research Council (NHMRC) of Australia and Servier. M.W. is a NHMRC of Australia Principal Research Fellow (1080206) Funding information
Funding Information:
T.O. reports no conflicts of interest. J.C. received research grants from the National Health and Medical Research Council of Australia and from Servier for the ADVANCE trial and ADVANCE‐ON post‐trial follow‐up, and honoraria for speaking about these studies at scientific meetings, and grant support from Program Grant APP1149987 from the National Health and Medical Research Council of Australia. M.C. reports grants from Novo Nordisk, grants and personal fees from Boehringer Ingelheim, and personal fees from Servier, AstraZeneca, Novartis, Merck and Bayer, outside the submitted work. P.H. reports consulting fees from Servier, and grant support from Quebec CQDM and Servier. S.H. reports grants from the George Institute for Global Health, during the conduct of the study, and other from Servier, outside the submitted work. M.M. received personal fees from Novo Nordisk, Sanofi, Eli Lilly, Merck Sharp and Dohme, Abbott, Novartis, Servier and AstraZeneca, and grant support from Novo Nordisk, Sanofi, Eli Lilly, Merck Sharp and Dohme and Novartis. G.M. reports personal fees from Servier Laboratories, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Medtronic, Novartis, Menarini Group, Recordati and Takeda Pharmaceutical Company. N.P. received honoraria and personal fees from Servier Laboratories, Takeda Pharmaceutical Company, Menarini Group and Pfizer, and grant support from Servier Laboratories and Pfizer. M.W. reports consultancy fees from Amgen and Kirin and is supported by an Australian National Health and Medical Research Council fellowship (APP1080206) and Program Grant (APP1149987).
Publisher Copyright:
© 2021 John Wiley & Sons Ltd
PY - 2021/6
Y1 - 2021/6
N2 - Aims: For relatively old patients with diabetes, current guidelines recommend adjustment of glycaemic goals based on patients' cognitive function, or coexisting chronic illnesses. However, the evidence which supports the efficacy and safety of intensive glucose lowering in older patients with diabetes is scarce. The objective of the present study was to compare the efficacy and safety of intensive glucose lowering in patients with type 2 diabetes stratified by age (<65 and ≥ 65 years), and examine whether the effects differ according to patients’ characteristics in the older patient group. Materials and Methods: The effects of intensive glucose lowering (to a target glycated haemoglobin [HbA1c] concentration of ≤48 mmol/mol [6.5%]) on major clinical outcomes were evaluated by Cox regression models according to subgroups defined by baseline age of <65 or ≥ 65 years in the ADVANCE trial (n = 11 140). Results: Over a median follow-up of 5 years, intensive glucose lowering significantly decreased the risk of the composite of major macrovascular and microvascular events (hazard ratio 0.90, 95% confidence interval 0.82-0.98), with no heterogeneity in the effects across age subgroups (p for heterogeneity = 0.44). Relative effects on all-cause death, cardiovascular death, and components of major vascular events were also similar (P for heterogeneity ≥0.06), except for severe hypoglycaemia, which was of greater risk for patients aged <65 years. Absolute benefits and harms were broadly consistent across subgroups. Among patients aged ≥65 years, randomized treatment effects did not differ significantly across different levels of cognitive function or coexisting chronic illnesses. Conclusions: Our results suggest that an intensive glycaemic control strategy to reduce HbA1c to 48 mmol/mol (6.5%) provided broadly similar benefits and harms and may be recommended for older, as well as younger, patients.
AB - Aims: For relatively old patients with diabetes, current guidelines recommend adjustment of glycaemic goals based on patients' cognitive function, or coexisting chronic illnesses. However, the evidence which supports the efficacy and safety of intensive glucose lowering in older patients with diabetes is scarce. The objective of the present study was to compare the efficacy and safety of intensive glucose lowering in patients with type 2 diabetes stratified by age (<65 and ≥ 65 years), and examine whether the effects differ according to patients’ characteristics in the older patient group. Materials and Methods: The effects of intensive glucose lowering (to a target glycated haemoglobin [HbA1c] concentration of ≤48 mmol/mol [6.5%]) on major clinical outcomes were evaluated by Cox regression models according to subgroups defined by baseline age of <65 or ≥ 65 years in the ADVANCE trial (n = 11 140). Results: Over a median follow-up of 5 years, intensive glucose lowering significantly decreased the risk of the composite of major macrovascular and microvascular events (hazard ratio 0.90, 95% confidence interval 0.82-0.98), with no heterogeneity in the effects across age subgroups (p for heterogeneity = 0.44). Relative effects on all-cause death, cardiovascular death, and components of major vascular events were also similar (P for heterogeneity ≥0.06), except for severe hypoglycaemia, which was of greater risk for patients aged <65 years. Absolute benefits and harms were broadly consistent across subgroups. Among patients aged ≥65 years, randomized treatment effects did not differ significantly across different levels of cognitive function or coexisting chronic illnesses. Conclusions: Our results suggest that an intensive glycaemic control strategy to reduce HbA1c to 48 mmol/mol (6.5%) provided broadly similar benefits and harms and may be recommended for older, as well as younger, patients.
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U2 - 10.1111/dom.14339
DO - 10.1111/dom.14339
M3 - Article
C2 - 33539672
AN - SCOPUS:85100995214
SN - 1462-8902
VL - 23
SP - 1292
EP - 1300
JO - Diabetes, Obesity and Metabolism
JF - Diabetes, Obesity and Metabolism
IS - 6
ER -
