Target-driven treatment may reduce macrovascular complications in type 2 diabetes
ORLANDO, Fla. — Lifespan was increased and the risk for macrovascular complications reduced in adults with type 2 diabetes when they participated in an intensified, multifactorial, target-driven treatment, according to a presenter here.
“Patients with type 2 diabetes should, as early as possible, be treated intensively for all risk factors in order to avoid diabetic late complications, and aggressive treatment matters, both with regard to length and quality of life,” Jens Christian Øllgaard, MD, PhD, a fellow at Slagelse Hospital, the University of Southern Denmark, Steno Diabetes Center, told Endocrine Today.
Øllgaard and colleagues evaluated 160 adults with type 2 diabetes and microalbuminuria randomly assigned to conventional (n = 80) or multifactorial therapy (n = 80) for 7.8 years to determine the effects of the treatment or risk for macrovascular and microvascular complications. Follow-up was conducted for 21 years.
The multifactorial therapy called for tighter treatment targets compared with the conventional therapy.
Overall, participants in the multifactorial therapy group had 7.9 additional years of medical survival time compared with the conventional therapy group. The multifactorial therapy group experienced first CVD events 8.1 years later compared with the conventional therapy group (P = .001).
Survival time after randomization and survival time before first CVD event were longer in the multifactorial therapy group compared with the conventional therapy group (HR = 0.36; 95% CI, 0.23-0.57). Similarly, the risks for coronary artery disease (HR = 0.43; 95% CI, .023-0.77), cerebrovascular disease (HR = .26; 95% CI0.12-0.55) and recurrent events (P = .049 for CAD; P = .003 for stroke) were lower in the multifactorial therapy group compared with the conventional group.
“Intensified multifactorial treatment of type 2 diabetes, complicated by microalbuminuria for 7.8 years increases life length and reduces and delays the development of severe CVD, such as stroke or myocardial infarction,” Øllgaard told Endocrine Today. “This means that the life years won by intensified treatment are spent in a good health state, which is very important for patients.”
Øllgaard added that the risks for macrovascular and microvascular complications need to be identified at an earlier stage of disease.
“This calls for further studies into biomarkers or novel risk factors associated with adverse outcomes,” he said. “Since diabetic complications are a societal problem, as much as a personal problem, investigations into the societal and economic impact of this treatment approach is needed in order to inform policy makers of the need for structured care, even at early disease progression.” – by Amber Cox
Øllgaard J, et al. OR11-1. Presented at: The Endocrine Society Annual Meeting; April 1-4, 2017; Orlando, Fla.
Disclosures: Øllgaard reports financial ties with Novo Nordisk. No other author reports relevant financial disclosures.