According to a report in the New England Journal of Medicine, 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%. In this open-label, parallel trial, 80 patients were randomised to conventional treatment in accordance with national guidelines and 80 to receive intensive treatment, with a stepwise implementation of behaviour modification and drug therapy that targeted hyperglycaemia, hypertension, dyslipidaemia, and microalbuminuria, along with secondary prevention of cardiovascular disease with aspirin.
The primary end point was a composite of death from cardiovascular causes, nonfatal MI, nonfatal stroke, revascularisation, and amputation. The mean age of the patients was 55.1 years, and the mean follow-up was 7.8 years. The decline in glycosylated haemoglobin 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% CI, 0.24 to 0.73), nephropathy (0.39; 95% CI, 0.17 to 0.87), retinopathy (0.42; 95% CI, 0.21 to 0.86), and autonomic neuropathy (0.37; 95% CI, 0.18 to 0.79).
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