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Prompt revascularization vs. medical therapy improved health in patients with type 2 diabetes, ischemic heart disease
Brooks M. Circulation. 2010;122:1690-1699.
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The health status of more than 2,000 patients with type 2 diabetes and stable ischemic heart disease improved in both prompt revascularization and medical therapy treatment groups, although the most notable improvements were demonstrated in the prompt revascularization arm, according to a new analysis of data from the BARI 2D trial.
Researchers of the BARI 2D trial randomly assigned patients (n=2,368) with type 2 diabetes and stable ischemic heart disease to prompt revascularization vs. medical therapy and insulin sensitization vs. insulin provision. The Duke Activity Status Index and RAND Energy, Health Distress and Self-Rated Health scales were determined at baseline and on an annual basis.
According to study results, each treatment arm reported improvements in health status at 1 year (P<.001). Prompt revascularization when compared with medical therapy significantly improved Duke Activity Status Index (+1.32 points; P<.001), Energy (+1.36; P=.02) and Self-rated Health (+1.77; P=.007), despite a negative trend with Health Distress (–0.47; P=.46); these effects were maintained during 4 years of follow-up.
No significant differences were reported in any of the four health status measurements between insulin provision and insulin sensitization arms.
“The BARI 2D clinical trial illustrates that intensive coordinated care of diabetes mellitus and cardiac risk factors results in clinically meaningful and statistically significant improvement in aspects of health status for patients with type 2 diabetes mellitus and stable ischemic heart disease,” researchers wrote. “The addition of prompt revascularization to intensive medical therapy resulted in small, statistically significant benefits in physical function and Self-Rated Health and marginally significant benefits in Energy.”
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