Intensive treatment lowered risks for morbid diabetes complications, all-cause death, and death from cardiovascular disease.
Patients who have type 2 diabetes mellitus and microalbuminuria can lower their risk for cardiovascular disease by following an intensive multifactorial treatment regimen. Until now, the effects of such treatment on risk for death in these patients have been unclear.
In this randomized Danish trial, 160 patients who had type 2 diabetes mellitus and microalbuminuria received either intensive target-driven treatment (targets included glycosylated hemoglobin level <6.5%, total serum cholesterol <175 mg/dL, and normal blood pressure) or conventional treatment for a mean of 7.8 years. Intensive-treatment patients received behavior modification programs (e.g., diet and exercise), aspirin, and renin-angiotensin blockers because of their microalbuminuria, regardless of blood pressure. Initial results, which showed lower incidences of a composite cardiovascular mortality and morbidity endpoint with intensive treatment, were published in 2003 (Journal Watch Feb 14 2003). Patients were then informed of the benefits of intensive treatment and were followed for an additional 5.5 years. During the 13.3 years of follow-up, all-cause death was significantly less common in the intensive treatment group (30%) than in the conventional treatment group (50%). Likewise, cardiovascular death, cardiovascular events, diabetic nephropathy, progression of diabetic neuropathy and retinopathy, and other adverse outcomes were significantly less common with intensive treatment than with conventional treatment.
Comment: This study was not designed to determine how much each intervention contributed to lowering risks for adverse outcomes. Nevertheless, the results justify intensive multifactorial target-driven treatment for patients with type 2 diabetes and microalbuminuria, because such treatment lowers risks for the clinically important endpoints of death and complications of diabetes.
— Paul S. Mueller, MD, MPH, FACP
Dr. Mueller is an Associate Professor of Medicine in the Division of General Internal Medicine at Mayo Clinic in Rochester, Minnesota.
Published in Journal Watch General Medicine February 6, 2008
Gæde P et al. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med 2008 Feb 7; 358:580.