This article is more than 5 years old. Information may no longer be current.
Intervention therapy reduced CVD in patients with type 2 diabetes
Click Here to Manage Email Alerts
Patients with type 2 diabetes at risk for cardiovascular disease may benefit from intensive intervention in the form of drug combination therapies and behavior modification.
In a follow-up to their Steno-2 study, researchers in Denmark analyzed the effect of multifactorial intervention on death rates in patients with type 2 diabetes at risk for cardiovascular disease. The researchers randomly assigned 160 patients with type 2 diabetes and microalbuminuria to intensive treatment or conventional therapy for a mean period of 7.8 years. The researchers followed patients for a mean 5.5 years. Follow-up time peaked at 13.3 years.
Deaths occurred in 24 patients in the intensive treatment group, compared with 40 in the conventional therapy cohort. A lower risk for both cardiovascular events and death by cardiovascular causes was linked to intensive therapy. Progression to end-stage renal disease occurred in one patient from the intensive treatment group, compared with six in the conventional therapy group. – by Stacey L. Adams
N Engl J Med. 2008;358:580-591.
This study is basically an extension of the Steno-2 study in which the results were first reported on several years ago. This study is extremely important because of the current media frenzy over the withdrawal of the intensively treated arm of the ACCORD trial, which was stopped due to excessive deaths. The Steno-2 study shows that when you treat diabetes in a multifactorial way—you get the blood pressure, the cholesterol and the glucose levels under control—the incidence of heart disease is reduced significantly. In my opinion, this is more of a real-life study than the ACCORD trial; however, it is important to remember that the ACCORD trial was designed to answer the important questions of whether tight glucose control can reduce macrovascular disease. The results of the Steno-2 study should have been in every newspaper; however, its impact and significance was lost by the ignorant and irresponsible journalism surrounding the ACCORD announcement.
This trial demonstrates that when you treat the whole patient, including the known cardiovascular risk factors, you can make a large impact on the morbidity and mortality in patients with type 2 diabetes. The Steno-2 study is important in that it shows exactly the opposite of what many people are panicking over with the ACCORD trial. However, the results are not a surprise because these results have already been demonstrated.
– Steve Edelman, MD
Endocrine Today Editorial Board member