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

doi:10.2337/dc11-0755

Original Research

Does Glycemic Control Offer Similar Benefits Among Patients With Diabetes in Different Regions of the World?

Results from the ADVANCE trial

Mark Woodward, PHD¹,² ⇓,
Anushka Patel, MD, PHD¹,
Sophia Zoungas, MD, PHD¹,³,
Lisheng Liu, MD⁴,
Changyu Pan, MD⁵,
Neil Poulter, MD⁶,
Andrzej Januszewicz, MD⁷,
Nikhil Tandon, PHD⁸,
Prashant Joshi, MD⁹,
Simon Heller, MD¹⁰,
Bruce Neal, MD, PHD¹ and
John Chalmers, MD, PHD¹

¹The George Institute, University of Sydney, Sydney, Australia
²Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
³School of Public Health, Monash University, Australia
⁴Chinese Hypertension League Institute, Beijing, China
⁵Chinese People’s Liberation Army General Hospital, Beijing, China
⁶Imperial College, London, U.K.
⁷Institute of Cardiology, Warsaw, Poland
⁸All India Institute of Medical Sciences, Delhi, India
⁹Government Medical College, Nagpur, India
¹⁰Sheffield Northern Hospital, Sheffield, U.K.

Corresponding author: Mark Woodward, mwoodward{at}georgeinstitute.org.au.

Diabetes Care 2011 Dec; 34(12): 2491-2495. https://doi.org/10.2337/dc11-0755

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.

Footnotes

Clinical trial reg. no. NCT00145925, clinicaltrials.gov.
This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc11-0755/-/DC1.
The sponsors had no role in the design of the study, data collection, data analysis, data interpretation, or writing of the manuscript. The Management Committee, whose membership did not include any sponsor representatives, had final responsibility for the decision to submit the manuscript for publication.

Received April 21, 2011.
Accepted August 28, 2011.

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