[Diabetes-talk] Diabetes abstract

[Ed Bryant]

The following abstract was carried in the New England Journal of Medicine.
It is about type2 diabetes and may or may not be of interest to you.

 

Regards,

Ed Bryant

 

http://content.nejm.org/cgi/content/short/360/24/2503?query=prevarrow

 

 

 

A Randomized Trial of Therapies for Type 2 Diabetes and Coronary Artery
Disease

 

The BARI 2D Study Group

 

ABSTRACT:

 

Background 

Optimal treatment for patients with both type 2 diabetes mellitus and stable
ischemic heart disease has not been established. 

 

Methods 

We randomly assigned 2368 patients with both type 2 diabetes and heart
disease to undergo either prompt revascularization with intensive medical
therapy or intensive medical therapy alone and to undergo either
insulin-sensitization or insulin-provision therapy. Primary end points were
the rate of death and a composite of death, myocardial infarction, or stroke
(major cardiovascular events). Randomization was stratified according to the
choice of percutaneous coronary intervention (PCI) or coronary-artery bypass
grafting (CABG) as the more appropriate intervention. 

 

Results

At 5 years, rates of survival did not differ significantly between the
revascularization group (88.3%) and the medical-therapy group (87.8%,
P=0.97) or between the insulin-sensitization group (88.2%) and the
insulin-provision group (87.9%, P=0.89). The rates of freedom from major
cardiovascular events also did not differ significantly among the groups:
77.2% in the revascularization group and 75.9% in the medical-treatment
group (P=0.70) and 77.7% in the insulin-sensitization group and 75.4% in the
insulin-provision group (P=0.13). In the PCI stratum, there was no
significant difference in primary end points between the revascularization
group and the medical-therapy group. In the CABG stratum, the rate of major
cardiovascular events was significantly lower in the revascularization group
(22.4%) than in the medical-therapy group (30.5%, P=0.01; P=0.002 for
interaction between stratum and study group). Adverse events and serious
adverse events were generally similar among the groups, although severe
hypoglycemia was more frequent in the insulin-provision group (9.2%) than in
the insulin-sensitization group (5.9%, P=0.003). 

 

Conclusions

 Overall, there was no significant difference in the rates of death and
major cardiovascular events between patients undergoing prompt
revascularization and those undergoing medical therapy or between strategies
of insulin sensitization and insulin provision. (ClinicalTrials.gov number,
NCT00006305 [ClinicalTrials.gov] .) 

 

 

 

Source Information

 

The members of the writing group (Robert L. Frye, M.D., Mayo Clinic,
Rochester, MN; Phyllis August, M.D., M.P.H., New York Hospital Queens,
Queens, NY; Maria Mori Brooks, Ph.D., Regina M. Hardison, M.S., Sheryl F.
Kelsey, Ph.D., Joan M. MacGregor, M.S., and Trevor J. Orchard, M.B., B.Ch.,
University of Pittsburgh, Pittsburgh; Bernard R. Chaitman, M.D., Saint Louis
University, St. Louis; Saul M. Genuth, M.D., Case Western Reserve
University, Cleveland; Suzanne H. Goldberg, R.N., M.S.N., National Heart,
Lung, and Blood Institute, Bethesda, MD; Mark A. Hlatky, M.D., Stanford
University, Palo Alto, CA; Teresa L.Z. Jones, M.D., National Institute of
Diabetes and Digestive and Kidney Diseases, Bethesda, MD; Mark E. Molitch,
M.D., Feinberg School of Medicine, Northwestern University, Chicago; Richard
W. Nesto, M.D., Lahey Clinic Medical Center, Burlington, MA; Edward Y. Sako,
M.D., Ph.D., University of Texas Health Science Center, San Antonio; and
Burton E. Sobel, M.D., University of Vermont, Burlington) assume
responsibility for the overall content and integrity of the article. 

 

This article (10.1056/NEJMoa0805796) was published on June 7, 2009, at
NEJM.org. 

 

Address reprint requests to Dr. Brooks at the Department of Epidemiology,
University of Pittsburgh Graduate School of Public Health, 130 DeSoto St.,
Pittsburgh, PA 15261, or at mbrooks at pitt.edu.