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Multifactorial Intervention Reduces Morbidity in Type 2 Diabetic Patients

An intensive intervention focusing on multiple risk factors was superior to conventional therapy -- now, the challenge is how to make such interventions broadly available.

In studies of preventive cardiovascular interventions among diabetic patients, researchers tend to examine outcomes after modification of a single risk factor. But what is the effect of a more comprehensive multifactorial intervention?

To address this question, Danish researchers randomly assigned 160 patients (mean age, 55) with type 2 diabetes and microalbuminuria to receive 1 of 2 interventions, starting in 1992. One group received intensive treatment, which included diet and exercise programs, smoking cessation courses, aspirin, angiotensin-converting-enzyme inhibitors or angiotensin-II-receptor blockers, and algorithms with specified treatment goals for glycosylated hemoglobin, blood pressure, and lipid levels; these patients were offered individual consultations with a multidisciplinary team every 3 months on average. The other group received conventional therapy with less stringent treatment goals, according to 1988 Danish guidelines. During an average follow-up of 8 years, a composite endpoint (cardiovascular death, nonfatal myocardial infarction, invasive coronary intervention, nonfatal stroke, amputation, or peripheral vascular surgery) occurred in 24% of intensively treated patients and in 44% of conventionally treated patients -- a significant difference. The intensive-treatment group also experienced significantly lower rates of nephropathy, retinopathy, and autonomic neuropathy.

Comment: These results confirm that an intensive intervention that focuses on multiple risk factors and that is administered by a dedicated team can prevent or delay complications in patients with type 2 diabetes. The challenge -- at least in the U.S. -- is to design a health care system capable of delivering such interventions to large numbers of diabetic patients.

— Allan S. Brett, MD

Published in Journal Watch General Medicine February 14, 2003

Citation(s):

Gaede P et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 2003 Jan 30; 348:383-93.

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