Intensified multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: the Steno type 2 randomised study

Steno Diabetes Centre, Gentofte, Copenhagen, Denmark.
The Lancet (Impact Factor: 45.22). 03/1999; 353(9153):617-22. DOI: 10.1016/S0140-6736(98)07368-1
Source: PubMed

ABSTRACT In type 2 diabetes mellitus the aetiology of long-term complications is multifactorial. We carried out a randomised trial of stepwise intensive treatment or standard treatment of risk factors in patients with microalbuminuria.
In this open, parallel trial patients were allocated standard treatment (n=80) or intensive treatment (n=80). Standard treatment followed Danish guidelines. Intensive treatment was a stepwise implementation of behaviour modification, pharmacological therapy targeting hyperglycaemia, hypertension, dyslipidaemia, and microalbuminuria. The primary endpoint was the development of nephropathy (median albumin excretion rate >300 mg per 24 h in at least one of the two-yearly examinations). Secondary endpoints were the incidence or progression of diabetic retinopathy and neuropathy.
The mean age was 55.1 years (SD 7.2) and patients were followed up for 3.8 years (0.3). Patients in the intensive group had significantly lower rates of progression to nephropathy (odds ratio 0.27 [95% CI 0-10-0.75]), progression of retinopathy (0.45 [0.21-0.95]), and progression of autonomic neuropathy (0.32 [0.12-0.78]) than those in the standard group.
Intensified multifactorial intervention in patients with type 2 diabetes and microalbuminuria slows progression to nephropathy, and progression of retinopathy and autonomic neuropathy. However, further studies are needed to establish the effect of intensified multifactorial treatment on macrovascular complications and mortality.

  • Source
    • "Unfortunately, such benefit is negligible when compared with the residual risk of microvascular complications observed during follow-up [9e11]. Indeed, over the 7.8 years treatment period, 51% of intensively treated patients developed or showed progression of diabetic retinophathy, diabetic nephropathy (25%) and peripheral neuropathy (55%) (Fig. 1) [10]. New microvascular complications developed and progressed during the extended follow-up period [9], despite an optimal control of blood pressure values (131 AE 13 and 73 AE 11 mmHg vs. 146 AE 18 vs 78 AE 10 mmHg) and Hb1 Ac (7.9 AE 1.2% vs 9.0 AE 1.8%) in the intensive as compared with conventional treatment group, respectively. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Risk of diabetic complications continues to escalate overtime despite a multifactorial intervention with glucose-lowering drugs, anti-hypertensive agents and statins. In this perspective, a mechanisms-based therapeutic approach to vascular disease in diabetes represents a major challenge. Epigenetic signatures are emerging as important determinants of vascular disease in this setting. Methylation and acetylation of DNA and histones is a reversible process leading to dysregulation of oxidant and inflammatory genes such as mitochondrial adaptor p66(Shc) and transcription factor NF-kB p65. Epigenetic modifications associated with diabetes may contribute to the early identification of high risk individuals. Ongoing epigenomic analyses will be instrumental in identifying the epigenetic variations that are specifically associated with cardiovascular disease in patients with diabetes. Here, we describe a complex scenario of epigenetic changes and their putative link with diabetic vascular disease. Pharmacological reprogramming of diabetes-induced epigenetic signatures may be a promising option to dampen oxidative stress and inflammation, and thus prevent cardiovascular complications in this setting.
    Atherosclerosis 10/2013; 230(2):191-7. DOI:10.1016/j.atherosclerosis.2013.07.003
  • Source
    • "Particular attention has been devoted to cardiometabolic risk [4] [5]. The reason is that cardio-metabolic diseases such as type 2 diabetes, cardio-vascular diseases and chronic kidney disease contribute heavily to disease burden [6] [7], while the risk can be considerably reduced by appropriate medication and adopting a healthy lifestyle [8] [9]. Accurate risk understanding is thought to be a core prerequisite for making well-informed decisions about risk-reducing behavior [10] [11] [12] [13]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: To study lay conceptions of cardio-metabolic risk and compare them with those of experts, in order to formulate focal points for better educational risk information. METHODS: 40 Dutch lay people were interviewed about the risks of developing cardio-metabolic diseases. Following a 'mental models approach', their conceptions were qualitatively analyzed and compared to an expert model. RESULTS: We identified four key themes representing lay conceptions: (1) "same factors, different value" (e.g. the dominance of certain factors, such as stress); (2) "superficiality and incoherence" (e.g. a focus on health and illness in general); (3) "misjudged elevated risk concept" (e.g. either being sick or not); and (4) "no concept of a link between cardio-metabolic diseases" (e.g. separate links between causes and diseases). CONCLUSION: Potential mismatches between lay and expert conceptions do not seem to indicate a lack of basic knowledge among consumers, but rather that certain risk factors are not effectively translated into a coherent risk picture. PRACTICE IMPLICATIONS: In improving educational materials, we could more explicitly take into account factors that lay people find important. Additionally, effort should be made to produce a more coherent risk understanding among consumers, for example through an alternative information structure.
    Patient Education and Counseling 08/2012; 89(2). DOI:10.1016/j.pec.2012.06.030
  • Source
    • "Measuring urinary albumin excretion is the method generally used to classify DN, and a stable increase in microalbuminuria is considered the first sign of renal damage [7] [8]. About 20–40% of type 2 diabetic patients progress to macroalbuminuria [9], and 40–50% of patients with microalbuminuria also suffer from cardiovascular disease [10]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The main aim of diabetic nephropathy monitoring is to identify molecular markers, that is, to find changes occurring at metabolome and proteome levels indicative of the disease's development. The mass spectrometry methods available today have been successfully applied to this field. This paper provides a short description of the basic aspects of the mass spectrometric methods used for diabetic nephropathy monitoring, reporting and discussing the results obtained using different approaches.
    05/2012; 2012:768159. DOI:10.5402/2012/768159
Show more