The Study
The Impact of Frailty on the Effectiveness and Safety of Intensive Glucose Control and Blood Pressure–Lowering Therapy for People With Type 2 Diabetes: Results From the ADVANCE Trial
This study looked at people with diabetes and noticed that those who were frailer (weaker, sicker, or more tired) had worse health outcomes and didn't seem to benefit as much from strict blood sugar and blood pressure control. But it didn't prove that being frail caused these differences—maybe frailer people were just older or had other health problems that made things worse.
Analysis score
Maximum 72 for a cohort study.
Where the score came from
This study looked at older people with diabetes to see if being frail (weak and vulnerable) changes how well tight control of blood sugar and blood pressure helps or hurts them.
Where does this study sit?
Reviews of RCTs (Meta-analyses)
Max 100Randomized Trials
Max 90Reviews of Cohort Studies
Max 85Cohort Studies
Max 72Reviews of Case-Control Studies
Max 63Case-Control Studies
Max 58Cross-Sectional & Case Series
Max 50Expert Opinion
Max 559 / 100
Quality score
Groups of people are followed over time to see who develops an outcome. Strong for identifying risk factors and associations, but cannot prove causation as firmly as RCTs.
Key takeaways
Summary
Based on the study abstract and findings.
- 1Yes — for frail older adults, aggressive treatment may do more harm than good, especially by causing dangerous low blood sugar, while offering less protection against heart and kidney problems.
- 2Frail people had 75% more severe low blood sugar episodes (8.39 vs 4.80 per 1,000 people per year) and got less protection from tight blood sugar control (HR 1.03 vs 0.84).
- 3Tight blood pressure control also helped less in frail people (HR 0.97 vs 0.86).
Score breakdown, methodology, conflicts of interest, evidence analysis & raw study data
Publication
Journal
Diabetes Care
Year
2021
Authors
T. Nguyen, K. Harris, M. Woodward, J. Chalmers, M. Cooper, P. Hamet, S. Harrap, S. Heller, S. MacMahon, G. Mancia, M. Marre, N. Poulter, A. Rogers, B. Williams, S. Zoungas, C. Chow, R. Lindley
Related Content
Claims (5)
In older adults, how frail a person is matters more than their age when deciding whether lowering blood pressure to below 120 mm Hg is safe and beneficial.
In older adults with type 2 diabetes, frailty is linked to a more than 50% higher risk of death from any cause and from cardiovascular disease, even when accounting for age, sex, and how diabetes is treated.
In older adults with type 2 diabetes, those with frailty experience less protection from intensive glucose control against heart and kidney complications compared to those without frailty.
Among older adults with type 2 diabetes who are receiving intensive glucose-lowering treatment, those who are frail experience severe low blood sugar at a rate 75% higher than those who are not frail.
In older adults with type 2 diabetes, aggressive blood pressure control results in a smaller reduction in combined heart and kidney complications for frail individuals compared to nonfrail individuals.
Not medical advice. For informational purposes only. Always consult a qualified healthcare professional before making health decisions.