Intensive intervention for type 2 diabetes, which addressed microalbuminuria, cholesterol, triglycerides, and blood pressure in addition to glucose control, reduced the risk of death by 20% over the course of 13 years in a Danish study.
Diabetes patients with persistent microalbuminuria who received about 8 years of intensive medical and behavioral therapy and were followed for an additional 5 years showed a 20% decline in absolute risk of death from any cause and a 13% decline in absolute risk of death from cardiovascular causes, compared with those receiving conventional care, said Dr. Peter Gaede of the Steno Diabetes Center, Copenhagen, and his associates.
They reported the 8-year results of their study previously; the current report reflects extended follow-up through 2006 of a cohort of 130 patients randomly assigned to receive either conventional diabetes treatment or therapy that targeted a glycated hemoglobin level of less than 6.5%, a fasting total cholesterol level of less than 175 mg/dL, a fasting serum triglyceride level of less than 150 mg/dL, a systolic blood pressure of less than 130 mm Hg, and a diastolic blood pressure of less than 80 mm Hg.
In addition to medications and lifestyle modifications to achieve those targets, those in the intensive-therapy group also received renin-angiotensin system blockers for microalbuminuria and low-dose aspirin. Overall mortality was 30% in the intensive-therapy group, compared with 50% in the conventional-care group. Nine of the patients (11%) in the intensive-therapy group died from cardiovascular causes, compared with 19 (24%) of the patients in the conventional-care group. There were 51 cardiovascular events in the intensive-care group and 158 in the conventional-care group. “The rate of death in the conventional-therapy group was 50%, a finding that underscores the poor prognosis for such patients in the absence of intensive treatment,” they said (N. Engl. J. Med. 2008;358:580–91).
Few serious effects were reported during regular follow-up interviews.
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