Multifactorial Intervention Reduces Morbidity in Type 2 Diabetic Patients

Journal Watch. 2003;2(2) 

Introduction

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.

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

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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