02499nas a2200265   4500000000100000008004100001100001100042700001100053700001900064700001400083700001300097700001800110700001900128700001500147700001400162700001600176700001500192700001800207245014400225250001500369300001100384490000700395520178500402020004602187       2011                            d1 aLiu L.1 aPan C.1 aJanuszewicz A.1 aTandon N.1 aJoshi P.1 aWoodward Mark1 aZoungas Sophia1 aPoulter N.1 aHeller S.1 aChalmers J.1 aNeal Bruce1 aPatel Anushka00aDoes glycemic control offer similar benefits among patients with diabetes in different regions of the world? Results from the ADVANCE trial  a2011/10/06  a2491-50 v343 a<p>
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.
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