title: Does glycemic control offer similar benefits among patients with diabetes in different regions of the world? Results from the ADVANCE trial.
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.
  
  
  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.
authors.affiliation: The George Institute, University of Sydney, Sydney, Australia. mwoodward@georgeinstitute.org.au
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.forename: Anushka
authors.initials: A
authors.lastname: Patel
authors.forename: Sophia
authors.initials: S
authors.lastname: Zoungas
authors.forename: Lisheng
authors.initials: L
authors.lastname: Liu
authors.forename: Changyu
authors.initials: C
authors.lastname: Pan
authors.forename: Neil
authors.initials: N
authors.lastname: Poulter
authors.forename: Andrzej
authors.initials: A
authors.lastname: Januszewicz
authors.forename: Nikhil
authors.initials: N
authors.lastname: Tandon
authors.forename: Prashant
authors.initials: P
authors.lastname: Joshi
authors.forename: Simon
authors.initials: S
authors.lastname: Heller
authors.forename: Bruce
authors.initials: B
authors.lastname: Neal
authors.forename: John
authors.initials: J
authors.lastname: Chalmers
mesh_terms: D000368:Aged; D001208:Asia / Q000453:epidemiology; D001315:Australia / Q000453:epidemiology; D001786:Blood Glucose / Q000187:drug effects*; D002170:Canada / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000401:mortality; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000517:prevention & control; D005060:Europe / Q000453:epidemiology; D005061:Europe, Eastern / Q000453:epidemiology; D005260:Female; D005907:Gliclazide / Q000008:administration & dosage / Q000627:therapeutic use*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007190:Indapamide / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D020913:Perindopril / Q000008:administration & dosage; D016016:Proportional Hazards Models
chemical_list: D001786:Blood Glucose; D005907:Gliclazide; D006442:Glycated Hemoglobin; D007190:Indapamide; D020913:Perindopril