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Effect of a multifactorial intervention on mortality in type 2 diabetes.
N Engl J Med 2008; 358(6):580-91NEJM

Abstract

BACKGROUND

Intensified multifactorial intervention - with tight glucose regulation and the use of renin-angiotensin system blockers, aspirin, and lipid-lowering agents - has been shown to reduce the risk of nonfatal cardiovascular disease among patients with type 2 diabetes mellitus and microalbuminuria. We evaluated whether this approach would have an effect on the rates of death from any cause and from cardiovascular causes.

METHODS

In the Steno-2 Study, we randomly assigned 160 patients with type 2 diabetes and persistent microalbuminuria to receive either intensive therapy or conventional therapy; the mean treatment period was 7.8 years. Patients were subsequently followed observationally for a mean of 5.5 years, until December 31, 2006. The primary end point at 13.3 years of follow-up was the time to death from any cause.

RESULTS

Twenty-four patients in the intensive-therapy group died, as compared with 40 in the conventional-therapy group (hazard ratio, 0.54; 95% confidence interval [CI], 0.32 to 0.89; P=0.02). Intensive therapy was associated with a lower risk of death from cardiovascular causes (hazard ratio, 0.43; 95% CI, 0.19 to 0.94; P=0.04) and of cardiovascular events (hazard ratio, 0.41; 95% CI, 0.25 to 0.67; P<0.001). One patient in the intensive-therapy group had progression to end-stage renal disease, as compared with six patients in the conventional-therapy group (P=0.04). Fewer patients in the intensive-therapy group required retinal photocoagulation (relative risk, 0.45; 95% CI, 0.23 to 0.86; P=0.02). Few major side effects were reported.

CONCLUSIONS

In at-risk patients with type 2 diabetes, intensive intervention with multiple drug combinations and behavior modification had sustained beneficial effects with respect to vascular complications and on rates of death from any cause and from cardiovascular causes. (ClinicalTrials.gov number, NCT00320008.)

Authors+Show Affiliations

Steno Diabetes Center, Copenhagen, Denmark.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18256393

Citation

Gaede, Peter, et al. "Effect of a Multifactorial Intervention On Mortality in Type 2 Diabetes." The New England Journal of Medicine, vol. 358, no. 6, 2008, pp. 580-91.
Gaede P, Lund-Andersen H, Parving HH, et al. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med. 2008;358(6):580-91.
Gaede, P., Lund-Andersen, H., Parving, H. H., & Pedersen, O. (2008). Effect of a multifactorial intervention on mortality in type 2 diabetes. The New England Journal of Medicine, 358(6), pp. 580-91. doi:10.1056/NEJMoa0706245.
Gaede P, et al. Effect of a Multifactorial Intervention On Mortality in Type 2 Diabetes. N Engl J Med. 2008 Feb 7;358(6):580-91. PubMed PMID: 18256393.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of a multifactorial intervention on mortality in type 2 diabetes. AU - Gaede,Peter, AU - Lund-Andersen,Henrik, AU - Parving,Hans-Henrik, AU - Pedersen,Oluf, PY - 2008/2/8/pubmed PY - 2008/2/13/medline PY - 2008/2/8/entrez SP - 580 EP - 91 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 358 IS - 6 N2 - BACKGROUND: Intensified multifactorial intervention - with tight glucose regulation and the use of renin-angiotensin system blockers, aspirin, and lipid-lowering agents - has been shown to reduce the risk of nonfatal cardiovascular disease among patients with type 2 diabetes mellitus and microalbuminuria. We evaluated whether this approach would have an effect on the rates of death from any cause and from cardiovascular causes. METHODS: In the Steno-2 Study, we randomly assigned 160 patients with type 2 diabetes and persistent microalbuminuria to receive either intensive therapy or conventional therapy; the mean treatment period was 7.8 years. Patients were subsequently followed observationally for a mean of 5.5 years, until December 31, 2006. The primary end point at 13.3 years of follow-up was the time to death from any cause. RESULTS: Twenty-four patients in the intensive-therapy group died, as compared with 40 in the conventional-therapy group (hazard ratio, 0.54; 95% confidence interval [CI], 0.32 to 0.89; P=0.02). Intensive therapy was associated with a lower risk of death from cardiovascular causes (hazard ratio, 0.43; 95% CI, 0.19 to 0.94; P=0.04) and of cardiovascular events (hazard ratio, 0.41; 95% CI, 0.25 to 0.67; P<0.001). One patient in the intensive-therapy group had progression to end-stage renal disease, as compared with six patients in the conventional-therapy group (P=0.04). Fewer patients in the intensive-therapy group required retinal photocoagulation (relative risk, 0.45; 95% CI, 0.23 to 0.86; P=0.02). Few major side effects were reported. CONCLUSIONS: In at-risk patients with type 2 diabetes, intensive intervention with multiple drug combinations and behavior modification had sustained beneficial effects with respect to vascular complications and on rates of death from any cause and from cardiovascular causes. (ClinicalTrials.gov number, NCT00320008.) SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/18256393/Effect_of_a_multifactorial_intervention_on_mortality_in_type_2_diabetes_ L2 - http://www.nejm.org/doi/full/10.1056/NEJMoa0706245?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -