Intensified treatment of patients with type 2 diabetes extends life by about 8 years
Intensified and multifaceted treatment of patients with type 2 diabetes and poor prognosis due to microalbuminuria extends median lifetime by 8 years compared with conventional therapy, according to a new long-term Danish follow-up study of the Steno-2 trial.
In the intensive treatment group, therapy took place at a specialised diabetes clinic and was intensified with a stepwise implementation of behavioural education (a low fat diet, more daily exercise and instructions on quitting tobacco) and multi-drug treatment of blood glucose, blood lipids, blood platelets, blood pressure and microalbuminuria. The control group was treated according to existing national guidelines for diabetes care and followed by their general practitioner, but had the opportunity of being referred to specialist treatment if required.
The original intervention involved 160 type 2 diabetes patients with microalbuminuria and was ended after 8 years. During the following 13 years, patients in both original treatment arms were ‒ in a post-trial setting ‒ instructed to follow the same multifactorial and intensified treatment modalities as originally given to the intensified group only.
At the follow-up 21 years after the initiation of the study, 38 intensive-therapy patients versus 55 conventional-therapy patients had died (meaning that the overall adjusted mortality rate in the intensively treated group was reduced by 45%). The patients in the intensive-therapy group survived for a median of 8 years longer than the conventional therapy group patients. Median time before first cardiovascular event after randomisation was also 8 years longer in the original intensive-therapy group. In addition, the risk for complications in the eyes and kidneys was reduced by 30–50%.
It is well-known that when left untreated the presence of microalbuminuria in patients with diabetes points to an even poorer prognosis with a major increase in the risk of cardiovascular complications and premature death.
|Hazard ratio – intensive vs conventional treatment (95% CI)||p|
|All-cause mortality||0.55 (0.36, 0.83)||0.005|
|CVD mortality||0.38 (0.19, 0.75)||0.006|
|CVD events||0.55 (0.39, 0.77)||0.001|
|Retinopathy progression||0.67 (0.51, 0.89)||0.005|
|Autonomic neuropathy||0.59 (0.40, 0.89)||0.011|
|Macroalbuminuria||0.52 (0.32, 0.84)||0.008|
Table: Selected secondary/tertiary endpoints showing risk reductions with intensive treatment. (N.B.no differences were observed for non-CVD mortality, death after specific number of CVD events and progression of peripheral neuropathy)
This 21-year follow-up study emphasises the need for early, intensified and individualised treatment of multiple modifiable risk factors in patients with type 2 diabetes and a poor prognosis associated with microalbuminuria.
Gaede P, Oellgaard J, Cartensen B, et al. Years of life gained by multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: 21 years follow-up on the Steno-2 randomised trial. Diabetologia 2016; DOI 10.1007/s00125-016-4065-6