Benefits of mulifactorial approach shown in Type 2 diabetes
medwireNews: Multifactorial treatment leads to better management of risk factors and significant improvements in prognosis for patients with Type 2 diabetes and diabetic nephropathy, Danish researchers report.
Treatment based on aggressive control of glucose, lipids and blood pressure – including renin-angiotensin system (RAS) inhibition – accompanied by acetylsalicylic acid and lifestyle advice was associated with a 50% reduction in mortality risk when compared with strategies that did not target multiple risk factors.
Gudbjörg Andrésdóttir, from the Steno Diabetes Centre in Gentofte, and colleagues collected demographic, clinical and laboratory data for 543 patients with Type 2 diabetes and diabetic nephropathy who were treated at the Steno Diabetes Center between 2000 and 2010.
They compared mortality and the rate of decline in glomerular filtration rate (GFR) in 286 of these patients, who had a minimum of three GFR measurements over at least 3 years, with a similar cohort of 227 patients treated between 1983 and 2002, which was before the implementation of multifactorial intervention.
Writing in Diabetes Care, the researchers report that the mean annual rate of decline in GFR fell by a significant 14%, from 5.2 mL/min per 1.73 m2 in 1983 to 2002 to 4.4 mL/min per 1.73 m2 in 2000 to 2010.
Compared with the historic cohort, the current cohort had a 42% lower risk of death, which increased to 50% when age was taken into account.
Andrésdóttir and team remark that these findings “coincide with and may depend upon better control of several modifiable cardiovascular risk factors and a marked rise in the use of RAS inhibition.”
Indeed, use of RAS inhibition increased from approximately 50% during 1983 to 2002 to 96% during 2000 to 2010 and the team observed significant improvements in the control of cardiovascular risk factors such as total cholesterol, body mass index, urinary albumin excretion rate, glycated haemoglobin and smoking in the current cohort at baseline, compared with the historic one.
Furthermore, mean follow-up measurements of total cholesterol, urinary albumin excretion rate, glycated haemoglobin and blood pressure appeared lower than at baseline in the current cohort, suggesting that “the benefits of multifactorial intervention […] may also apply after onset of established [diabetic nephropathy]”, note the authors.
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By Laura Cowen, medwireNews Reporter