How to ADVANCE prevention of cardiovascular complications in type 2 diabetes.

Patients suffering from type 2 diabetes are at increased risk of macrovascular and microvascular disease. This review assesses the available evidence for hypertension and hyperglycemia as risk factors for vascular disease in type 2 diabetes mellitus. Several studies showing a benefit of antihypertensive treatment and glucose-lowering therapy on the prevention of macrovascular and microvascular disease are discussed. However, questions remain concerning the overall balance of benefits and risks of intensive target-driven blood pressure and blood glucose control in type 2 diabetes. More well-powered intervention and prevention studies are therefore needed to provide the necessary reliable evidence to answer these questions. The Action in Diabetes and Vascular disease: PreterAx and DiamicroN modified release Controlled Evaluation (ADVANCE) study is discussed as a trial designed to resemble clinical practice that promises to provide answers concerning the value conferred by blood pressure-lowering therapy and intensive glucose control therapy in type 2 diabetes patients at high risk for cardiovascular disease.