The Pharmaceutical Journal
Vol 270 No 7235 p179
8 February 2003

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Study confirms benefit of intensive therapy in type 2 diabetes mellitus

Intensive therapy, including lifestyle and drug interventions, in the management of type 2 diabetes reduces the risk of cardiovascular and microvascular events by about 50 per cent compared with conventional treatment, report Danish researchers.

Dr Peter Gæde, of the Steno Diabetes Centre, Copenhagen, and colleagues point out that, although several diabetes guidelines recommend intensive multifactorial treatment, the effect of such an approach has not been confirmed in long-term studies.

They therefore randomly assigned 160 patients with type 2 diabetes and microalbuminuria to receive conventional care or intensive treatment and followed their progress for an average of 7.8 years. Patients in the intensive therapy group were treated with lifestyle and drug interventions that targeted hyperglycaemia, hypertension, dyslipidaemia, and microalbuminuria, along with secondary prevention of cardiovascular disease with aspirin. Biochemical and clinical data were obtained every third month in these patients and after four and eight years in both groups.

The researchers report 85 cardiovascular events among 35 of the 80 patients (44 per cent) in the conventional therapy group compared with 33 events among 19 of the 80 patients (24 per cent) in the intensive therapy group.

"In addition, the reductions in the risk of nephropathy, retinopathy, and autonomic neuropathy obtained after four years of the intervention were maintained at eight years," they say. The researchers point out that, because many national guidelines recommend using protocols and therapeutic targets such as the ones used in the study, it may be difficult to replicate the findings. "However, future studies might address several key questions, including which type of care organisation is most effective in implementing this approach to treatment," they say (New England Journal of Medicine 2003;348:383).

In an accompanying editorial (ibid, p457), Dr Caren Solomon says: "That a multifactorial approach substantially reduced cardiovascular risk is not in itself surprising. Previous studies have shown benefits of several components of this approach. But the study conducted by Gæde et al provides the best evidence to date of the magnitude of the benefit that can be derived from instituting several interventions."