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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

Aims/hypothesis The aim of this work was to study the potential long-term impact of a 7.8 years intensified, multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria in terms of gained years of life and years free from incident cardiovascular disease. Methods The or... Full description

Journal Title: Diabetologia 2016-08-16, Vol.59 (11), p.2298-2307
Main Author: Gæde, Peter
Other Authors: Oellgaard, Jens , Carstensen, Bendix , Rossing, Peter , Lund-Andersen, Henrik , Parving, Hans-Henrik , Pedersen, Oluf
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: Berlin/Heidelberg: Springer Berlin Heidelberg
ID: ISSN: 0012-186X
Link: https://www.ncbi.nlm.nih.gov/pubmed/27531506
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recordid: cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5506099
title: 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
format: Article
creator:
  • Gæde, Peter
  • Oellgaard, Jens
  • Carstensen, Bendix
  • Rossing, Peter
  • Lund-Andersen, Henrik
  • Parving, Hans-Henrik
  • Pedersen, Oluf
subjects:
  • Adult
  • Aged
  • Aged, 80 and over
  • Albuminuria
  • Albuminuria - drug therapy
  • Albuminuria - mortality
  • Albuminuria - therapy
  • Article
  • Cardiovascular disease
  • Cardiovascular Diseases
  • Cardiovascular Diseases - prevention & control
  • Care and treatment
  • Diabetes
  • Diabetes complications
  • Diabetes Complications - prevention & control
  • Diabetes mellitus
  • Diabetes mellitus, type 2
  • Diabetes Mellitus, Type 2 - drug therapy
  • Diabetes Mellitus, Type 2 - mortality
  • Diabetes Mellitus, Type 2 - therapy
  • Diabetic Nephropathies
  • Diabetic Nephropathies - prevention & control
  • Diabetic nephropathy
  • Diabetic Neuropathies
  • Diabetic Neuropathies - prevention & control
  • Diabetic neuropathy
  • Diabetic retinopathy
  • Diabetic Retinopathy - prevention & control
  • drug therapy
  • Endocrinology
  • Female
  • Follow
  • Follow-Up Studies
  • Human Physiology
  • Humans
  • Hypoglycemic Agents
  • Hypoglycemic Agents - therapeutic use
  • Internal Medicine
  • Male
  • Medicine
  • Medicine & Public Health
  • Metabolic Diseases
  • Metabolism
  • Middle Aged
  • over
  • prevention & control
  • therapeutic use
  • Time Factors
  • type 2
  • Type 2 diabetes
  • up studies
ispartof: Diabetologia, 2016-08-16, Vol.59 (11), p.2298-2307
description: Aims/hypothesis The aim of this work was to study the potential long-term impact of a 7.8 years intensified, multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria in terms of gained years of life and years free from incident cardiovascular disease. Methods The original intervention (mean treatment duration 7.8 years) involved 160 patients with type 2 diabetes and microalbuminuria who were randomly assigned (using sealed envelopes) to receive either conventional therapy or intensified, multifactorial treatment including both behavioural and pharmacological approaches. After 7.8 years the study continued as an observational follow-up with all patients receiving treatment as for the original intensive-therapy group. The primary endpoint of this follow-up 21.2 years after intervention start was difference in median survival time between the original treatment groups with and without incident cardiovascular disease. Non-fatal endpoints and causes of death were adjudicated by an external endpoint committee blinded for treatment allocation. Results Thirty-eight intensive-therapy patients vs 55 conventional-therapy patients died during follow-up (HR 0.55 [95% CI 0.36, 0.83], p  = 0.005). The patients in the intensive-therapy group survived for a median of 7.9 years longer than the conventional-therapy group patients. Median time before first cardiovascular event after randomisation was 8.1 years longer in the intensive-therapy group ( p  = 0.001). The hazard for all microvascular complications was decreased in the intensive-therapy group in the range 0.52 to 0.67, except for peripheral neuropathy (HR 1.12). Conclusions/interpretation At 21.2 years of follow-up of 7.8 years of intensified, multifactorial, target-driven treatment of type 2 diabetes with microalbuminuria, we demonstrate a median of 7.9 years of gain of life. The increase in lifespan is matched by time free from incident cardiovascular disease. Trial registration: ClinicalTrials.gov registration no. NCT00320008. Funding: The study was funded by an unrestricted grant from Novo Nordisk A/S.
language: eng
source:
identifier: ISSN: 0012-186X
fulltext: no_fulltext
issn:
  • 0012-186X
  • 1432-0428
url: Link


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titleYears 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
creatorGæde, Peter ; Oellgaard, Jens ; Carstensen, Bendix ; Rossing, Peter ; Lund-Andersen, Henrik ; Parving, Hans-Henrik ; Pedersen, Oluf
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descriptionAims/hypothesis The aim of this work was to study the potential long-term impact of a 7.8 years intensified, multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria in terms of gained years of life and years free from incident cardiovascular disease. Methods The original intervention (mean treatment duration 7.8 years) involved 160 patients with type 2 diabetes and microalbuminuria who were randomly assigned (using sealed envelopes) to receive either conventional therapy or intensified, multifactorial treatment including both behavioural and pharmacological approaches. After 7.8 years the study continued as an observational follow-up with all patients receiving treatment as for the original intensive-therapy group. The primary endpoint of this follow-up 21.2 years after intervention start was difference in median survival time between the original treatment groups with and without incident cardiovascular disease. Non-fatal endpoints and causes of death were adjudicated by an external endpoint committee blinded for treatment allocation. Results Thirty-eight intensive-therapy patients vs 55 conventional-therapy patients died during follow-up (HR 0.55 [95% CI 0.36, 0.83], p  = 0.005). The patients in the intensive-therapy group survived for a median of 7.9 years longer than the conventional-therapy group patients. Median time before first cardiovascular event after randomisation was 8.1 years longer in the intensive-therapy group ( p  = 0.001). The hazard for all microvascular complications was decreased in the intensive-therapy group in the range 0.52 to 0.67, except for peripheral neuropathy (HR 1.12). Conclusions/interpretation At 21.2 years of follow-up of 7.8 years of intensified, multifactorial, target-driven treatment of type 2 diabetes with microalbuminuria, we demonstrate a median of 7.9 years of gain of life. The increase in lifespan is matched by time free from incident cardiovascular disease. Trial registration: ClinicalTrials.gov registration no. NCT00320008. Funding: The study was funded by an unrestricted grant from Novo Nordisk A/S.
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descriptionAims/hypothesis The aim of this work was to study the potential long-term impact of a 7.8 years intensified, multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria in terms of gained years of life and years free from incident cardiovascular disease. Methods The original intervention (mean treatment duration 7.8 years) involved 160 patients with type 2 diabetes and microalbuminuria who were randomly assigned (using sealed envelopes) to receive either conventional therapy or intensified, multifactorial treatment including both behavioural and pharmacological approaches. After 7.8 years the study continued as an observational follow-up with all patients receiving treatment as for the original intensive-therapy group. The primary endpoint of this follow-up 21.2 years after intervention start was difference in median survival time between the original treatment groups with and without incident cardiovascular disease. Non-fatal endpoints and causes of death were adjudicated by an external endpoint committee blinded for treatment allocation. Results Thirty-eight intensive-therapy patients vs 55 conventional-therapy patients died during follow-up (HR 0.55 [95% CI 0.36, 0.83], p  = 0.005). The patients in the intensive-therapy group survived for a median of 7.9 years longer than the conventional-therapy group patients. Median time before first cardiovascular event after randomisation was 8.1 years longer in the intensive-therapy group ( p  = 0.001). The hazard for all microvascular complications was decreased in the intensive-therapy group in the range 0.52 to 0.67, except for peripheral neuropathy (HR 1.12). Conclusions/interpretation At 21.2 years of follow-up of 7.8 years of intensified, multifactorial, target-driven treatment of type 2 diabetes with microalbuminuria, we demonstrate a median of 7.9 years of gain of life. The increase in lifespan is matched by time free from incident cardiovascular disease. Trial registration: ClinicalTrials.gov registration no. NCT00320008. Funding: The study was funded by an unrestricted grant from Novo Nordisk A/S.
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11Care and treatment
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17Diabetes Mellitus, Type 2 - drug therapy
18Diabetes Mellitus, Type 2 - mortality
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20Diabetic Nephropathies
21Diabetic Nephropathies - prevention & control
22Diabetic nephropathy
23Diabetic Neuropathies
24Diabetic Neuropathies - prevention & control
25Diabetic neuropathy
26Diabetic retinopathy
27Diabetic Retinopathy - prevention & control
28drug therapy
29Endocrinology
30Female
31Follow
32Follow-Up Studies
33Human Physiology
34Humans
35Hypoglycemic Agents
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37Internal Medicine
38Male
39Medicine
40Medicine & Public Health
41Metabolic Diseases
42Metabolism
43Middle Aged
44over
45prevention & control
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48type 2
49Type 2 diabetes
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titleYears 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
authorGæde, Peter ; Oellgaard, Jens ; Carstensen, Bendix ; Rossing, Peter ; Lund-Andersen, Henrik ; Parving, Hans-Henrik ; Pedersen, Oluf
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1Aged
2Aged, 80 and over
3Albuminuria
4Albuminuria - drug therapy
5Albuminuria - mortality
6Albuminuria - therapy
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8Cardiovascular disease
9Cardiovascular Diseases
10Cardiovascular Diseases - prevention & control
11Care and treatment
12Diabetes
13Diabetes complications
14Diabetes Complications - prevention & control
15Diabetes mellitus
16Diabetes mellitus, type 2
17Diabetes Mellitus, Type 2 - drug therapy
18Diabetes Mellitus, Type 2 - mortality
19Diabetes Mellitus, Type 2 - therapy
20Diabetic Nephropathies
21Diabetic Nephropathies - prevention & control
22Diabetic nephropathy
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26Diabetic retinopathy
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abstractAims/hypothesis The aim of this work was to study the potential long-term impact of a 7.8 years intensified, multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria in terms of gained years of life and years free from incident cardiovascular disease. Methods The original intervention (mean treatment duration 7.8 years) involved 160 patients with type 2 diabetes and microalbuminuria who were randomly assigned (using sealed envelopes) to receive either conventional therapy or intensified, multifactorial treatment including both behavioural and pharmacological approaches. After 7.8 years the study continued as an observational follow-up with all patients receiving treatment as for the original intensive-therapy group. The primary endpoint of this follow-up 21.2 years after intervention start was difference in median survival time between the original treatment groups with and without incident cardiovascular disease. Non-fatal endpoints and causes of death were adjudicated by an external endpoint committee blinded for treatment allocation. Results Thirty-eight intensive-therapy patients vs 55 conventional-therapy patients died during follow-up (HR 0.55 [95% CI 0.36, 0.83], p  = 0.005). The patients in the intensive-therapy group survived for a median of 7.9 years longer than the conventional-therapy group patients. Median time before first cardiovascular event after randomisation was 8.1 years longer in the intensive-therapy group ( p  = 0.001). The hazard for all microvascular complications was decreased in the intensive-therapy group in the range 0.52 to 0.67, except for peripheral neuropathy (HR 1.12). Conclusions/interpretation At 21.2 years of follow-up of 7.8 years of intensified, multifactorial, target-driven treatment of type 2 diabetes with microalbuminuria, we demonstrate a median of 7.9 years of gain of life. The increase in lifespan is matched by time free from incident cardiovascular disease. Trial registration: ClinicalTrials.gov registration no. NCT00320008. Funding: The study was funded by an unrestricted grant from Novo Nordisk A/S.
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