Intensive glycaemic control does not seem to reduce all cause mortality in patients with type 2 diabetes .
OBJECTIVE To assess the effect of targeting intensive glycaemic control versus conventional glycaemic control on  all cause mortality and cardiovascular mortality , non-fatal myocardial infa rct ion , microvascular complications , and severe hypoglycaemia in patients with type 2 diabetes .
Effects of blood pressure lowering and intensive glucose control on the incidence and progression of retinopathy in patients with type 2 diabetes mellitus: a randomised controlled trial
Aims /hypothesisThe aim of the present study was to investigate the effect of blood pressure lowering and intensive glucose control on the incidence and progression of retinopathy in type 2 diabetic patients . Methods The Action in Diabetes and Vascular Disease : Preterax and Diamicron MR Controlled Evaluation ( ADVANCE ) Retinal Measurements study , a sub study of ADVANCE , is a r and omised ( using a central , computer-based procedure ) controlled 2 × 2 factorial trial comprising a double-blind comparison of blood pressure lowering with perindopril – indapamide vs placebo , and an open comparison of st and ard vs intensive glucose control targeting a HbA1c of ≤ 6.5 % in 1,602 diabetic patients from ADVANCE centres with access to retinal cameras conducted from 2001 to 2008 . At baseline and the final visit , seven-field stereoscopic retinal photographs were taken and grade d by blinded readers ( grade able baseline and final photographs from 1,241 patients ) . Progression of ≥2 steps in the Early Treatment of Diabetic Retinopathy Study classification ( using the eye with worst grading ) was the primary outcome . Results Retinopathy progressed in 59 ( 4.8 % ) patients and developed in 128 ( 10.3 % ) patients over 4.1 years . Fewer patients on blood pressure-lowering treatment ( n = 623 ) experienced incidence or progression of retinopathy compared with patients on placebo ( n = 618 ) , but the difference was not significant ( OR 0.78 ; 95 % CI 0.57–1.06 ; p = 0.12 ) . Blood pressure-lowering treatment reduced the occurrence of macular oedema ( OR 0.50 ; 95 % CI 0.29–0.88 ; p = 0.016 ) and arteriovenous nicking compared with placebo ( OR 0.60 ; 95 % CI 0.38–0.94 ; p = 0.025 ) . Compared with st and ard glucose control ( n = 611 ) , intensive glucose control ( n = 630 ) did not reduce ( p = 0.27 ) the incidence and progression of retinopathy ( OR 0.84 ; 95 % CI 0.61–1.15 ) . Lower , borderline significant risks of microaneurysms , hard exu date s and macular oedema were observed with intensive glucose control , adjusted for baseline retinal haemorrhages . These effects of the two treatments were independent and additive . Adverse events in the ADVANCE study are reported elsewhere . Conclusions /interpretationBlood pressure lowering or intensive glucose control did not significantly reduce the incidence and progression of retinopathy , although consistent trends towards a benefit were observed , with significant reductions in some lesions observed with both interventions .Trial registration : Clinical Trials.gov ID no. NCT00145925 . Funding : Grants from Servier and the National Health and Medical Research Council of
Intensive glycaemic control does not seem to reduce all cause mortality in patients with type 2 diabetes .
OBJECTIVE To assess the effect of targeting intensive glycaemic control versus conventional glycaemic control on  all cause mortality and cardiovascular mortality , non-fatal myocardial infa rct ion , microvascular complications , and severe hypoglycaemia in patients with type 2 diabetes .