BARI-2D BYPASS ANGIOPLASTY REVASCULARIZATION INVESTIGATION 2 DIABETES

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Diabetes is a disease in which blood sugar (glucose) levels are abnormally high, causing damage to many organs, such as the eyes, kidneys, and the nerves. Lowering blood glucose levels to normal helps to prevent such damage. We suspect that high blood glucose is also bad for the heart, because diabetic individuals with especially high blood glucose are more likely to suffer heart attacks and death. In type 2 diabetes, high blood glucose results from two things: (1) the pancreas does not supply enough insulin; and (2) the body does not react well enough to whatever insulin it receives. We now have drugs to improve both of these problems and bring blood glucose levels down close to normal. Insulin Providers (IP) are types of drugs that increase the supply of insulin, and Insulin Sensitizers (IS) are drugs that increase the reaction of the body to insulin. However, we do not know which type of drug is better, particularly for type 2 diabetics, like yourself. Coronary artery disease is a process that results in hardening of the arteries. When the arteries that supply blood and oxygen to your heart muscle become clogged or narrowed, a heart attack may result, or you may feel chest discomfort (angina) sometimes even while resting. Patients with Type 2 Diabetes develop coronary artery disease and other cardiovascular complications 2-3 times more often as similarly aged persons without diabetes. The best treatment for patients with diabetes and coronary artery disease is unclear. There are three kinds of approaches: treatment with medicines, coronary artery bypass (open heart) surgery, and balloon angioplasty. As a diabetic patient with heart disease, you are being asked to take part in a research study know as BARI 2D. This 2300 patient, 8-year study in the U.S. and Canada in designed to compare whether initial treatment of coronary artery disease with angioplasty (PCI) or surgery (CABG) is better than starting with an aggressive medical program which focuses on modifying your risk factors such as high cholesterol and obesity. At the same time, this study will compare the two different approaches for the treatment of diabetes explained above.