Cardiovascular morbidity is a major burden in patients with type 2 diabetes. In the
Steno-2 Study, we compared the effect of a targeted, intensified, multifactorial intervention
with that of conventional treatment on modifiable risk factors for cardiovascular
disease in patients with type 2 diabetes and microalbuminuria.
The primary end point of this open, parallel trial was a composite of death from cardiovascular
causes, nonfatal myocardial infarction, nonfatal stroke, revascularization, and amputation.
Eighty patients were randomly assigned to receive conventional treatment in accordance
with national guidelines and 80 to receive intensive treatment, with a stepwise implementation
of behavior modification and pharmacologic therapy that targeted hyperglycemia, hypertension,
dyslipidemia, and microalbuminuria, along with secondary prevention of cardiovascular
disease with aspirin.
The mean age of the patients was 55.1 years, and the mean follow-up was 7.8 years.
The decline in glycosylated hemoglobin values, systolic and diastolic blood pressure,
serum cholesterol and triglyceride levels measured after an overnight fast, and urinary
albumin excretion rate were all significantly greater in the intensive-therapy group
than in the conventional-therapy group. Patients receiving intensive therapy also
had a significantly lower risk of cardiovascular disease (hazard ratio, 0.47; 95 percent
confidence interval, 0.24 to 0.73), nephropathy (hazard ratio, 0.39; 95 percent confidence
interval, 0.17 to 0.87), retinopathy (hazard ratio, 0.42; 95 percent confidence interval,
0.21 to 0.86), and autonomic neuropathy (hazard ratio, 0.37; 95 percent confidence
interval, 0.18 to 0.79).
A target-driven, long-term, intensified intervention aimed at multiple risk factors
in patients with type 2 diabetes and microalbuminuria reduces the risk of cardiovascular
and microvascular events by about 50 percent.
Copyright 2003 Massachusetts Medical Society