Effect of a multifactorial intervention on mortality in type 2 diabetes
Effect of a multifactorial intervention on mortality in type 2 diabetes
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DOI：
10.1056/nejmoa0706245
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发表时间：
2008-02-07
影响因子：
158.5
通讯作者：
Pedersen, Oluf
中科院分区：
文献类型：
--
作者：
Gaede, Peter;Lund-Andersen, Henrik;Pedersen, Oluf
背景：强化多因素干预——严格的血糖调控以及使用肾素 - 血管紧张素系统阻滞剂、阿司匹林和降脂药物——已被证明可降低2型糖尿病合并微量白蛋白尿患者发生非致命性心血管疾病的风险。我们评估了这种方法是否会对任何原因导致的死亡以及心血管原因导致的死亡率产生影响。
方法：在Steno - 2研究中，我们将160例2型糖尿病且持续存在微量白蛋白尿的患者随机分配接受强化治疗或常规治疗；平均治疗期为7.8年。随后对患者进行平均5.5年的观察随访，直至2006年12月31日。随访13.3年的主要终点是任何原因导致的死亡时间。
结果：强化治疗组有24例患者死亡，而常规治疗组有40例（风险比为0.54；95%置信区间[CI]为0.32 - 0.89；P = 0.02）。强化治疗与心血管原因导致的死亡风险降低相关（风险比为0.43；95%CI为0.19 - 0.94；P = 0.04）以及心血管事件风险降低相关（风险比为0.41；95%CI为0.25 - 0.67；P（此处原文似乎不完整）
Background: Intensified multifactorial intervention -- with tight glucose regulation and the use of renin-angiotensin system blockers, aspirin, and lipid-lowering agents -- has been shown to reduce the risk of nonfatal cardiovascular disease among patients with type 2 diabetes mellitus and microalbuminuria. We evaluated whether this approach would have an effect on the rates of death from any cause and from cardiovascular causes.Methods: In the Steno-2 Study, we randomly assigned 160 patients with type 2 diabetes and persistent microalbuminuria to receive either intensive therapy or conventional therapy; the mean treatment period was 7.8 years. Patients were subsequently followed observationally for a mean of 5.5 years, until December 31, 2006. The primary end point at 13.3 years of follow-up was the time to death from any cause.Results: Twenty-four patients in the intensive-therapy group died, as compared with 40 in the conventional-therapy group (hazard ratio, 0.54; 95% confidence interval [CI], 0.32 to 0.89; P=0.02). Intensive therapy was associated with a lower risk of death from cardiovascular causes (hazard ratio, 0.43; 95% CI, 0.19 to 0.94; P=0.04) and of cardiovascular events (hazard ratio, 0.41; 95% CI, 0.25 to 0.67; P