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Woodward, M.; Patel, A.; Zoungas, S.; Liu, L.; Pan, C.; Poulter, N.; Januszewicz, A.; Tandon, N.; Joshi, P.; Heller, S.; Neal, B.; Chalmers, J. (2011)
Publisher: American Diabetes Association
Journal: Diabetes Care
Languages: English
Types: Article
Subjects: Blood Glucose, Europe, Eastern, Perindopril, Clinical Care/Education/Nutrition/Psychosocial Research, Gliclazide, New Zealand, Endocrinology & Metabolism, Diabetic Angiopathies, Indapamide, Hemoglobin A, Glycosylated, Diabetes Mellitus, Type 2, Female, Europe, Life Sciences & Biomedicine, Asia, Aged, Australia, Middle Aged, Science & Technology, Canada, 11 Medical And Health Sciences, Original Research, Humans, Male, Proportional Hazards Models
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.\ud \ud 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 HbAlc of ≤6.5%, were compared across regions using Cox proportional hazards models.\ud \ud 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.\ud \ud 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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    • 1. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:1047- 1053
    • 2. International Diabetes Federation. Diabetes atlas 2010 [article online], 2011. Available from http://www.diabetesatlas.org/. Accessed 29 September 2011
    • 3. Burgers JS, Bailey JV, Klazinga NS, Van Der Bij AK, Grol R, Feder G; AGREE COLLABORATION. Inside guidelines: comparative analysis of recommendations and evidence in diabetes guidelines from 13 countries. Diabetes Care 2002;25:1933- 1939
    • 4. Patel A, MacMahon S, Chalmers J, et al.; ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008;358:2560-2572
    • 5. ADVANCE Management Committee. Rationale and design of the ADVANCE study: a randomised trial of blood pressure lowering and intensive glucose control in high-risk individuals with type 2 diabetes mellitus. Action in Diabetes and Vascular Disease: PreterAx and DiamicroN Modified-Release Controlled Evaluation. J Hypertens Suppl 2001;19:S21-S28
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