BYPASS ANGIOPLASTY REVASCULARIZATION INVESTIGATION 2 DIABETES (BARI 2D)

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 2型糖尿病是冠状动脉疾病(CAD)及其死亡率的最大危险因素之一。对于这一大群患者的最佳治疗方法尚不清楚。冠状动脉血运重建术虽然越来越多地被使用，但与高血糖、高血压、血脂异常和其他危险因素的治疗一起使用时，并没有显示出更多的益处。此外，虽然密集的降低HbA1c的努力已被证明在微血管并发症方面有利于影响2型糖尿病的临床病程，但关于大血管结局的最佳高血糖治疗策略尚不清楚。这项研究的目的是确定：1)初始选择性冠状动脉血运重建术联合积极药物治疗的有效性，与单独积极药物治疗的初始策略相比；以及2)提供更多胰岛素(内源性或外源性)的策略与增加对胰岛素敏感性(减少胰岛素抵抗)的策略在管理高血糖方面的有效性，每种策略的目标糖化血红蛋白水平为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.