OBJECTIVEdParticipants 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 METHODSdADVANCE 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.
RESULTSdWhen 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.
CONCLUSIONSdIrrespective 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.