Effect of a multifactorial intervention on mortality in type 2 diabetes - PubMed (original) (raw)
Randomized Controlled Trial
. 2008 Feb 7;358(6):580-91.
doi: 10.1056/NEJMoa0706245.
Affiliations
- PMID: 18256393
- DOI: 10.1056/NEJMoa0706245
Free article
Randomized Controlled Trial
Effect of a multifactorial intervention on mortality in type 2 diabetes
Peter Gaede et al. N Engl J Med. 2008.
Free article
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.)
Copyright 2008 Massachusetts Medical Society.
Comment in
- Does multi-pronged therapy for type 2 diabetes lower mortality?
[No authors listed] [No authors listed] J Fam Pract. 2008 May;57(5):302. J Fam Pract. 2008. PMID: 18464331 No abstract available. - Multifactorial intervention and mortality in type 2 diabetes.
Schroeder SA. Schroeder SA. N Engl J Med. 2008 May 22;358(21):2292; author reply 2292-3. doi: 10.1056/NEJMc080536. N Engl J Med. 2008. PMID: 18499577 No abstract available. - Multifactorial intervention and mortality in type 2 diabetes.
Tayek JA. Tayek JA. N Engl J Med. 2008 May 22;358(21):2292; author reply 2292-3. N Engl J Med. 2008. PMID: 18504827 No abstract available. - Does an intensive multifactorial intervention reduce mortality in type 2 diabetes mellitus?
Zinman B. Zinman B. Nat Clin Pract Endocrinol Metab. 2008 Aug;4(8):434-5. doi: 10.1038/ncpendmet0868. Epub 2008 Jun 24. Nat Clin Pract Endocrinol Metab. 2008. PMID: 18578014 No abstract available.
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