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Intensified multifactorial intervention and cardiovascular outcome in type 2 diabetes: the Steno-2 study.

Abstract

We recently published the results of the Steno-2 study, which evaluated the benefits of intensified integrated behavior modification and targeted polypharmacy. The results provide abundant evidence that an ambitious treatment strategy is superior to a conventional one. The study involved 160 high-risk type 2 diabetic patients with microalbuminuria-a strong risk factor of both macrovascular and microvascular complications-aged 55.1 years, who were randomly assigned to a conventional or an intensive, multifactorial intervention for a period of 7.8 years. In the intensive group, a stepwise treatment plan was adopted involving both continuous lifestyle education and motivation and an ambitious goal-oriented pharmacological treatment of known modifiable risk factors. The conventional group was treated in accordance with national guidelines for type 2 diabetes with less stringent goals. The specific significant group differences in the degree of change in key clinical and biochemical variables at the end of the study were (in the intensive group): lower systolic and diastolic blood pressures, hemoglobin A(1c) (HbA(1c)), fasting serum total and low-density lipoprotein (LDL) cholesterol, fasting serum triglycerides, and 24-hour urine albumin excretion, as well as increased carbohydrate and decreased fat intake as percentage of total energy. There was no difference in weight gain between groups during follow-up and no other major side effects were reported. The primary end point was a macrovascular outcome: a composite of death from cardiovascular causes, nonfatal myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention, nonfatal stroke, amputation for ischemia, or vascular surgery for peripheral arterial atherosclerosis. The differences between groups in surrogate end points translated into the following significant group differences in final clinical end points: 44% of patients in the conventional group had a cardiovascular event compared with 24% in the intensive group, ie, a relative risk reduction of about 50%. Also, the relative risk of nephropathy, retinopathy, and autonomic neuropathy (secondary end points) was diminished by about 60% in the intensively treated group. In conclusion, an intensified and goal-oriented multipronged approach to the treatment of type 2 diabetes reduces cardiovascular events, as well as nephropathy, retinopathy, and autonomic neuropathy, by about half. The challenge is to ensure that this experience is widely adopted in daily practice.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Steno Diabetes Center, Copenhagen, Denmark.

    Source

    Metabolism: clinical and experimental 52:8 Suppl 1 2003 Aug pg 19-23

    MeSH

    Behavior Therapy
    Diabetes Mellitus, Type 2
    Diabetic Angiopathies
    Evidence-Based Medicine
    Humans
    Polypharmacy
    Randomized Controlled Trials as Topic

    Pub Type(s)

    Clinical Trial
    Journal Article
    Randomized Controlled Trial
    Review

    Language

    eng

    PubMed ID

    12939735

    Citation

    Pedersen, Oluf, and Peter Gaede. "Intensified Multifactorial Intervention and Cardiovascular Outcome in Type 2 Diabetes: the Steno-2 Study." Metabolism: Clinical and Experimental, vol. 52, no. 8 Suppl 1, 2003, pp. 19-23.
    Pedersen O, Gaede P. Intensified multifactorial intervention and cardiovascular outcome in type 2 diabetes: the Steno-2 study. Metab Clin Exp. 2003;52(8 Suppl 1):19-23.
    Pedersen, O., & Gaede, P. (2003). Intensified multifactorial intervention and cardiovascular outcome in type 2 diabetes: the Steno-2 study. Metabolism: Clinical and Experimental, 52(8 Suppl 1), pp. 19-23.
    Pedersen O, Gaede P. Intensified Multifactorial Intervention and Cardiovascular Outcome in Type 2 Diabetes: the Steno-2 Study. Metab Clin Exp. 2003;52(8 Suppl 1):19-23. PubMed PMID: 12939735.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Intensified multifactorial intervention and cardiovascular outcome in type 2 diabetes: the Steno-2 study. AU - Pedersen,Oluf, AU - Gaede,Peter, PY - 2003/8/27/pubmed PY - 2003/10/1/medline PY - 2003/8/27/entrez SP - 19 EP - 23 JF - Metabolism: clinical and experimental JO - Metab. Clin. Exp. VL - 52 IS - 8 Suppl 1 N2 - We recently published the results of the Steno-2 study, which evaluated the benefits of intensified integrated behavior modification and targeted polypharmacy. The results provide abundant evidence that an ambitious treatment strategy is superior to a conventional one. The study involved 160 high-risk type 2 diabetic patients with microalbuminuria-a strong risk factor of both macrovascular and microvascular complications-aged 55.1 years, who were randomly assigned to a conventional or an intensive, multifactorial intervention for a period of 7.8 years. In the intensive group, a stepwise treatment plan was adopted involving both continuous lifestyle education and motivation and an ambitious goal-oriented pharmacological treatment of known modifiable risk factors. The conventional group was treated in accordance with national guidelines for type 2 diabetes with less stringent goals. The specific significant group differences in the degree of change in key clinical and biochemical variables at the end of the study were (in the intensive group): lower systolic and diastolic blood pressures, hemoglobin A(1c) (HbA(1c)), fasting serum total and low-density lipoprotein (LDL) cholesterol, fasting serum triglycerides, and 24-hour urine albumin excretion, as well as increased carbohydrate and decreased fat intake as percentage of total energy. There was no difference in weight gain between groups during follow-up and no other major side effects were reported. The primary end point was a macrovascular outcome: a composite of death from cardiovascular causes, nonfatal myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention, nonfatal stroke, amputation for ischemia, or vascular surgery for peripheral arterial atherosclerosis. The differences between groups in surrogate end points translated into the following significant group differences in final clinical end points: 44% of patients in the conventional group had a cardiovascular event compared with 24% in the intensive group, ie, a relative risk reduction of about 50%. Also, the relative risk of nephropathy, retinopathy, and autonomic neuropathy (secondary end points) was diminished by about 60% in the intensively treated group. In conclusion, an intensified and goal-oriented multipronged approach to the treatment of type 2 diabetes reduces cardiovascular events, as well as nephropathy, retinopathy, and autonomic neuropathy, by about half. The challenge is to ensure that this experience is widely adopted in daily practice. SN - 0026-0495 UR - https://www.unboundmedicine.com/medline/citation/12939735/Intensified_multifactorial_intervention_and_cardiovascular_outcome_in_type_2_diabetes:_the_Steno_2_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/aS0026049503002130 DB - PRIME DP - Unbound Medicine ER -