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Original Article
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Volume 358:580-591 February 7, 2008 Number 6
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Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes
Peter Gæde, M.D., D.M.Sc., Henrik Lund-Andersen, M.D., D.M.Sc., Hans-Henrik Parving, M.D., D.M.Sc., and Oluf Pedersen, M.D., D.M.Sc.

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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 [ClinicalTrials.gov] .)


Source Information

From the Steno Diabetes Center, Copenhagen (P.G., H.L.-A., O.P.); Department of Ophthalmology, Glostrup University Hospital, Glostrup (H.L.-A.); Department of Medical Endocrinology, Rigshospitalet Copenhagen University Hospital, Copenhagen (H.-H.P.); and Faculty of Health Sciences, University of Aarhus, Aarhus (H.-H.P., O.P.) — all in Denmark.

Address reprint requests to Dr. Pedersen at the Steno Diabetes Center, 2820 Gentofte, Copenhagen, Denmark, or at oluf{at}steno.dk.

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Related Letters:

Multifactorial Intervention and Mortality in Type 2 Diabetes
Schroeder S. A., Tayek J. A., Gæde P., Parving H.-H., Pedersen O.
Extract | Full Text | PDF  
N Engl J Med 2008; 358:2292-2293, May 22, 2008. Correspondence

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