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Intensive treatment of type 2 diabetes with microalbuminuria reaps benefits

Patients live longer, and with fewer complications, than those treated conventionally

Caroline White

Friday, 02 September 2016

Intensive multi-pronged treatment of patients with type 2 diabetes and vascular damage can halve the development of complications and prolong life by an average of eight years, suggests research* published in the journal Diabetologia.

A proportion of patients with diabetes have an excess of albumin in the urine (microalbuminuria), reflecting generalised vascular damage that is associated with a major increase in the risk of cardiovascular complications and premature death.

The researchers carried out a follow up study to their STENO-2 study, which compared intensive with standard treatment in 160 patients with type 2 diabetes and microalbuminuria.

The new study assessed the differences in average lifespan between the two groups of patients, measured in years of life gained, to emphasise the much lower life expectancy that patients with type 2 diabetes and microalbuminuria usually have.

The intensive treatment regimen was delivered in a specialist diabetes clinic, and consisted of stepwise implementation of continued behavioural education (a healthy diet, more daily exercise and instructions on quitting tobacco) combined with drugs to target blood glucose, blood lipids, blood platelets, blood pressure and microalbuminuria.

Patients given conventional therapy were treated in accordance with existing national guidelines for diabetes under the care of their family doctor.

During the following 13 years of follow up, patients in both original treatment arms were assigned to intensive treatment.

At the end of 21 years, 38 patients in the intensive treatment group had died, compared with 55 in the standard treatment group, meaning that the original group of intensively treated patients were 45% less likely to die.

They lived an average of eight years longer than those in the standard treatment group. And the average length of time before a first cardiovascular event was also eight years longer. Furthermore, the risk of eye and kidney complications was significantly reduced (30-50%).

“The outcome of our study is very encouraging and emphasises the need for early and intensified treatment of multiple modifiable risk factors for a poor prognosis of patients with type 2 diabetes,” says co-author Dr Peter Gaede of Slagelse Hospital and the University of Southern Denmark, Odense, Denmark.

“This long-term follow-up of the Steno-2 study demonstrates beyond any doubt the sustainability of the intensified and multipronged treatment approach of type 2 diabetes patients with microalbuminuria introduced by us more than 21 years ago, said senior co-author Dr Hans-Henrik Parving, National University Hospital of Copenhagen.

“The benefits for the patients in terms of a major extension of life and a halving of new cardiovascular complications speak for themselves” he added.

* Gæde P, 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, first online: 16 August 2016. DOI: 10.1007/s00125-016-4065-6

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