Intense, long-term intervention
for Type 2 diabetes cuts risk of cardiovascular (CV) and microvascular events by
about half.
This is the finding of multi-center study in Denmark led by Dr Peter Gaede from
the Steno Diabetes Centre, Copenhagen.
Cardiovascular (CV) morbidity remains a major problem among patients with type
two diabetes, especially those with microalbuminuria.
The investigators compared conventional with intensive therapy involving
stepwise implementation of behaviour modification and pharmacologic therapy
targeted at hyperglycemia, hypertension, dyslipidemia and microalbuminuria,
along with secondary prevention of CV disease with aspirin.
Primary end point in the open, parallel (Steno-2) study, was a composite of
death from CV causes, nonfatal myocardial infarction, nonfatal stroke,
revascularisation and amputation.
Eighty patients were randomly assigned to receive conventional treatment (per
national guidelines) and 80 to receive intensive treatment.
Mean age of the patients was 55.1 years, and mean follow-up was 7.8 years.
Decline in glycosylated hemoglobin values, systolic and diastolic blood
pressure, serum cholesterol and triglyceride levels measured after an overnight
fast, and urinary albumin excretion rate were all significantly greater in the
intensive- than in the conventional-therapy group.
Patients on the intensive therapy also had a significantly lower risk of CV
disease, nephropathy, retinopathy and autonomic neuropathy than did those on
conventional therapy.
Source: Diabetes In Control Dot Com: New England Journal of Medicine 2003;348:383-393.
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