Tags

Type your tag names separated by a space and hit enter

Effect of a multifactorial intervention on mortality in type 2 diabetes.

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.)

Links

  • FREE Publisher Full Text
  • Authors+Show Affiliations

    ,

    Steno Diabetes Center, Copenhagen, Denmark.

    , ,

    Source

    The New England journal of medicine 358:6 2008 Feb 07 pg 580-91

    MeSH

    Aged
    Angiotensin-Converting Enzyme Inhibitors
    Aspirin
    Behavior Therapy
    Cardiovascular Diseases
    Cause of Death
    Combined Modality Therapy
    Diabetes Mellitus, Type 2
    Diabetic Neuropathies
    Drug Therapy, Combination
    Follow-Up Studies
    Humans
    Hypoglycemic Agents
    Hypolipidemic Agents
    Kaplan-Meier Estimate
    Middle Aged
    Platelet Aggregation Inhibitors
    Risk Factors

    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 -