Lifelong benefits from early multifactorial diabetes intervention
medwireNews: Nearly 2 decades after the launch of the Steno-2 study, patients with complicated diabetes given intensive multifactorial treatment have gained nearly 8 years of life, say the researchers.
“Furthermore, the increased lifespan was matched by the years gained free from incident [cardiovascular disease]”, they write in Diabetologia.
The study involved 160 patients with Type 2 diabetes and microalbuminuria. After the randomised treatment period, which lasted 7.8 years, all patients were moved onto the intensive intervention, which incorporated more ambitious targets and treatment additional risk factors for late diabetic complications.
Despite all patients moving to intensive treatment, those who received it from the outset lived for a median of at least 7.9 years more than those who initially received standard care. And Oluf Pedersen (University of Copenhagen, Denmark) and co-researchers caution that this could be an underestimate; 69% of the standard-treatment group died during the 21.2 years of follow-up, compared with only 48% of the intensive-treatment group, meaning the median survival of the latter group was not reached.
Likewise, the median time to first cardiovascular disease event or death was 16.1 years in the intensive-treatment group, compared with 8.0 years in the standard-treatment group.
“We interpret the continuing beneficial effects seen in the trial as a direct consequence of early intervention intensification in patients at lower absolute risk for late diabetic complications compared with a situation wherein increased vascular damage is already present with intensification in later stages of the disease”, say Pedersen et al.
They note that recurrent cardiovascular disease events were common all round, yet these were around half as likely to occur in the intensive-treatment than the standard-treatment group, at 24% versus 43%.
Intensive treatment also had lasting positive effects on microvascular complications, conferring a 33% reduction in progression of retinopathy and a 48% reduction in progression to macroalbuminuria. There was no effect on progression to peripheral neuropathy, but autonomic neuropathy was reduced by 41%.
“We must emphasise the significance of early, intensified risk factor control in patients with complicated type 2 diabetes”, conclude the researchers. “This approach is already broadly implemented according to clinical guidelines and the present findings should lead to even more focus on the potential preventive effects.”
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