BYPASS ANGIOPLASTY REVASCULARIZATION INVESTIGATION 2 DIABETES (BARI 2D)

该子项目是利用NIH/NCRR资助的中心赠款提供的资源的许多研究子项目之一。子项目和研究者（PI）可能从另一个NIH来源获得主要资金，因此可以在其他CRISP条目中表示。所列机构为中心，不一定是研究者所在机构。2型糖尿病是冠状动脉疾病（CAD）和随之而来的死亡率的最强危险因素之一。目前尚不清楚这一大群患者的最佳治疗方法。冠状动脉血运重建虽然越来越多地使用，但当沿着管理高血糖、高血压、血脂异常和其他风险因素时，并未显示出增加的益处。此外，虽然降低HbA 1c的密集努力已被证明在微血管并发症方面有利地影响2型糖尿病的临床病程，但关于大血管结局的最佳高血糖管理策略尚不清楚。本研究的目的是确定：1）初始选择性冠状动脉血运重建联合积极的药物治疗的有效性，与初始策略单独的积极的药物治疗相比;和2）提供更多胰岛素的策略的功效（内源性或外源性）与增加胰岛素敏感性的策略（降低胰岛素抵抗）治疗高血糖症，每种策略的目标HbA 1c水平< 7.0%。

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. Type 2 diabetes mellitus is one of the strongest risk factors for coronary artery disease (CAD) and consequent mortality. The optimal treatment for this large group of patients is not yet known. Coronary revascularization, while increasingly used, has not been shown to be of increased benefit when used along with management of hyperglycemia, hypertension, dyslipidemia and other risk factors. Further, while intensive efforts to lower HbA1c have been demonstrated to favorably affect the clinical course of Type 2 diabetes mellitus in terms of microvascular complications, the optimal hyperglycemia management strategy with regard to macrovascular outcome is not known. The purpose of this study is to determine: 1) the efficacy of initial elective coronary revascularization combined with aggressive medical therapy, compared to an initial strategy of aggressive medical therapy alone; and 2) the efficacy of a strategy of providing more insulin (endogenous or exogenous) versus a strategy of increasing sensitivity to insulin (reducing insulin resistance) in the management of hyperglycemia, with a target HbA1c level of < 7.0% for each strategy.