OBJECTIVE
The objective of ADVANCE is to determine the effects of more intensive blood pressure lowering and glucose control on the risks of complications in patients with type 2 diabetes. ADVANCE also had two substudies:

• ADREM: ADVANCE Retinopathy Measurements
  The aim of this sub study is to measure the incidence and progression of background retinopathy by blood pressure lowering or intensive glucose lowering in patients with type 2 diabetes. 1,978 baseline studies have been received from participants in Australia, Canada, China, Estonia, Germany, India, Ireland, Malaysia, Netherlands, Slovakia, and the UK. The grading of the two-year follow-up studies has also begun.
• ADEPT: PROVIDE THE FULL FORM
  The aim of ADEPT is to determine whether aggressive blood pressure lowering and glucose control will improve left ventricular diastolic function and structure (LV mass) in patients with type 2 diabetes. ADEPT is one of the largest cross-sectional echocardiographic datasets with contemporary echocardiography methods in patients with type 2 diabetes. A total of 570 eligible baseline echocardiograms were taken from participants in Australia, Ireland, New Zealand, and the UK. To date, 549 six-month echocardiograms have been performed. Four-year scans will begin in March 2006.
  

INVESTIGATORS
Institute Investigators:

• Stephen MacMahon
• John Chalmers
• Bruce Neal
• Anushka Patel

CARE Hospitals:

• Krishnam Raju
• Bipin Sethi
• Mazhar Ali
• Moinuddin Admed
• Nilayini G

APPROACH

The study is a factorial, multicentre, randomised controlled trial. 11,140 participants have been 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 regimen or standard guidelines-based glucose lowering therapy. Follow-up will be for an average of four and a half years. The primary outcomes will be major macrovascular complications (stroke and heart attack) and major microvascular complications (eye and renal disease).

BENEFITS

RESULTS
The trial has completed recruitment on schedule and has now entered the follow-up phase. Final results are expected to be available in 2006. Major sub-studies examining the eye and heart in detail are also under way.

STUDENTSHIP (PhD – join research)

FUNDING AGENCIEScil (NHMRC)

COLLABORATION
The study was conducted with the collaboration of the following:

• University of Melbourne, Australia
• University of Auckland, New Zealand
• Chinese Academy of Medical Sciences, Beijing
• Imperial College, UK
• University of Montreal, Canada
• Utrecht University, The Netherlands
• 215 clinical centres in 20 countries worldwide

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