Intense approach to diabetes add-on extends lives

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Intensified and multifaceted treatment of type 2 diabetes and a common complication called microalbuminuria extends media lifetime by eight years.

The results of the long-term study appear in the journal Diabetologia.

A subset of type 2 diabetes patients have microalbuminuria—a slight excess of albumin in the urine—which reflects generalized vascular damage. When left untreated, microalbuminuria in patients with diabetes points to an even poorer prognosis with a major increase in the risk of cardiovascular complications and premature death.

“The outcome of our study is very encouraging and emphasizes the need for early and intensified treatment of multiple modifiable risk factors for a poor prognosis of patients with type 2 diabetes,” says a first author of the paper, Peter Gaede of Slagelse Hospital and University of Southern Denmark.

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The authors did their follow-up study on the Steno-2 study, a randomized trial of intensified versus standard multifactorial intervention for almost eight years in patients with type 2 diabetes and microalbuminuria.

Past reports from the Steno-2 study have shown the effectiveness of the more intensive intervention, in which “development of complications in the eyes, kidneys, legs, heart, and brain is halved compared with conventional multifactorial treatment,” says co-first author Jens Oellgaard of Slagelse Hospital and University of Southern Denmark and Steno Diabetes Centre.

Intensive treatment

In the intensive treatment group, therapy took place at a specialized diabetes clinic and was target-driven and intensified continued behavioral education (a green and low fat diet, more daily exercise, and instructions on quitting tobacco) and multi-drug treatment of blood glucose, blood lipids, blood platelets, blood pressure, and microalbuminuria following a structured approach.

Patients undergoing conventional therapy worked with their general practitioner, but had the opportunity at all times of specialist treatment if required. The control group received multifactorial treatment according to existing national guidelines for diabetes care.

The original intervention involved 160 type 2 diabetes patients with microalbuminuria and ended after 8 years. During the following 13 years, patients in both original treatment arms were in a post-trial setting instructed to follow the same multifactorial and intensified treatment modalities as originally given to the intensified group only.

Longer lives

At the follow-up 21 years after the initiation of the study, 38 intensive-therapy patients versus 55 conventional-therapy patients had died (meaning the original intensively treated patients were 45 percent less likely to die). The patients in the intensive-therapy group survived for a median of eight years longer than the conventional-therapy group patients.

Importantly, median time before first cardiovascular event after randomization was also eight years longer in the original intensive-therapy group meaning that the additional eight years of life is likely to correspond to the extra eight years free of new cardiovascular complications. In addition, the risk for complications in the eyes and kidneys was reduced by 30-50 percent.

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“This long-term follow-up of the Steno-2 study demonstrates beyond any doubt the sustainability of the intensified and multipronged treatment approach of type 2 diabetes patients with microalbuminuria introduced by us more than 21 years ago. The benefits for the patients in terms of a major extension of life and a halving of new cardiovascular complications speak for themselves,” says one of the paper’s senior authors, Hans-Henrik Parving of the National University Hospital of Copenhagen.

Source: University of Copenhagen