Abstract:
OBJECTIVE:Participants in ADVANCE were drawn from many countries. We examined whether the effects of intensive glycemic control on major outcomes in ADVANCE differ between participants from Asia, established market economies (EMEs), and eastern Europe. RESEARCH DESIGN AND METHODS:ADVANCE was a clinical trial of 11,140 patients with type 2 diabetes, lasting a median of 5 years. Demographic and clinical characteristics were compared across regions using generalized linear and mixed models. Effects on outcomes of the gliclazide modified release-based intensive glucose control regimen, targeting an HbA(lc) of ≤6.5%, were compared across regions using Cox proportional hazards models. RESULTS:When differences in baseline variables were allowed for, the risks of primary outcomes (major macrovascular or microvascular disease) were highest in Asia (joint hazard ratio 1.33 [95% CI 1.17-1.50]), whereas macrovascular disease was more common (1.19 [1.00-1.42]) and microvascular disease less common (0.77 [0.62-0.94]) in eastern Europe than in EMEs. Risks of death and cardiovascular death were highest in eastern Europe, and the mean difference in glycosylated hemoglobin between the intensive and standard groups was lowest in EMEs. Despite these and other differences, the effects of intensive glycemic control were not significantly different (P ≥ 0.23) between regions for any outcome, including mortality, vascular end points, and severe hypoglycemic episodes. CONCLUSIONS:Irrespective of absolute risk, the effects of intensive glycemic control with the gliclazide MR-based regimen used in ADVANCE were similar across Asia, EMEs, and eastern Europe. This regimen can safely be recommended for patients with type 2 diabetes in all of these regions.
journal_name
Diabetes Carejournal_title
Diabetes careauthors
Woodward M,Patel A,Zoungas S,Liu L,Pan C,Poulter N,Januszewicz A,Tandon N,Joshi P,Heller S,Neal B,Chalmers Jdoi
10.2337/dc11-0755subject
Has Abstractpub_date
2011-12-01 00:00:00pages
2491-5issue
12eissn
0149-5992issn
1935-5548pii
dc11-0755journal_volume
34pub_type
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