Does glycemic control offer similar benefits among patients with diabetes in different regions of the world? Results from the ADVANCE trial

Mark Woodward, Anushka Patel, Sophia Zoungas, Lisheng Liu, Changyu Pan, Neil Poulter, Andrzej Januszewicz, Nikhil Tandon, Prashant Joshi, Simon Heller, Bruce Neal, John Chalmers, Mark Woodward, Anushka Patel, Sophia Zoungas, Lisheng Liu, Changyu Pan, Neil Poulter, Andrzej Januszewicz, Nikhil Tandon, Prashant Joshi, Simon Heller, Bruce Neal, John Chalmers

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.

Trial registration: ClinicalTrials.gov NCT00145925.

Figures

Figure 1
Figure 1
Relative risk reduction, intensive vs. standard glycemic control, for primary outcomes and main secondary outcomes in ADVANCE. The bars show 95% CIs, and the diamonds show the overall estimate, also illustrated by the vertical line. The width of the diamonds shows the 95% CI for the overall result.

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Source: PubMed

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