An intensive approach for preventing coronary events and all-cause mortality in type 2 diabetes (T2D) yields results similar to those seen with standard care, according to a study published in the December issue of Lancet Diabetes & Endocrinology.
“Our results do not fully support the efficacy of further intensified multifactorial intervention compared with current standard care for the prevention of a composite of coronary events, cerebrovascular events, and all-cause mortality,” wrote first author Kohjiro Ueki, MD, of Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan, and colleagues with the Japan Diabetes Optimal Treatment (J-DOIT3) study group.
However, they noted that the results suggest intensified management may have a benefit for the prevention of cerebrovascular events in T2D, especially stroke.
While research suggests that tight glucose control may decrease microvascular complications in T2D, that control alone may not be enough to decrease macrovascular complications. Also, intensive glucose control can increase the risk of severe hypoglycemia, which may trigger cardiac events.
Limited research suggests that a multifactorial approach focused on intensive control of blood glucose, lipids, and hypertension may improve macrovascular outcomes and mortality in T2D.
To further evaluate the issue, Ueki and colleagues conducted an open-label randomized study at 81 clinics in Japan between June 2006 and March 2016.
- Participants included 2542 patients with T2D who were aged 45-69, and had hypertension, dyslipidemia and A1c ≥ 6.9%.
- Participants were randomized to standard therapy according to Japanese guidelines (n=1271), or intensive therapy (n=1271).
|A1c||< 6.9||< 6.2|
|LDL-C||120 (100 w/ CAD)||< 80 (70 w/ ACD|
- Primary outcome: composite of heart attack, stroke, revascularization, and all-cause mortality. Patients were followed for a median of 8.5 years.
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