Article

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.

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    • "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. "
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