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- May 17, 2008 |
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"Multifactorial Intervention and Cardiovascular Disease in Patients with Type 2 Diabetes - 'Steno 2'"Dr. Oluf Pedersen (biography)
English - 2003-06-16 - 49 minutes
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Summary :
The Steno-2 Study was designed in 1990, when there was no evidence base for the treatment of type 2 diabetes, and studies such as the UKPDS were ongoing. Steno-2 was an attempt to validate the efficacy of daily clinical practice, i.e., the multifactorial treatment of type 2 diabetes, in high-risk type 2 diabetes patients. The aim of the study was to investigate the impact on microvascular and cardiovascular disorders, of a target driven behaviour modification and polypharmacy as compared to a conventional multifactorial treatment of high-risk type 2 diabetic patients with the metabolic syndrome including microalbuminuria. A prospective, randomized, open, blinded endpoint (PROBE) design was used, where one hundred and sixty patients with type 2 diabetes and the metabolic syndrome including microalbuminuria were assigned to conventional therapy with their GP, or to intensive care at Steno Diabetes Center. After 4 years a 50% reduction in microvascular endpoints – nephropathy, retinopathy and neuropathy (The Lancet 353: 617-22. 1999) was reported. The intensive group was treated differently by means of individualized risk assessment, ambitious goal setting, focused behaviour modification, more drugs and higher doses prescribed, and continued patient education and motivation. After 7.8 years duration the study showed an absolute risk reduction of 20% for CVD, and the relative risk reductions for microvascular events were as follows: nephropathy 61%, retinopathy 58% and autonomic neuropathy 63%. This talk will outline the details of the study procedure and present the latest clinical data obtained from Steno-2.
Learning objectives :
The participant will learn about the objectives and findings of the Steno-2 Study, which took place in Denmark in the 1990s:
- The aim of the study was to investigate the impact on microvascular and cardiovascular disorders, of a target driven behaviour modification and polypharmacy as compared to a conventional multifactorial treatment of high-risk type 2 diabetic patients with the metabolic syndrome including microalbuminuria.
- After 7.8 years duration the study showed an absolute risk reduction of 20% for CVD, and the relative risk reductions for microvascular events were as follows: nephropathy 61%, retinopathy 58% and autonomic neuropathy 63%.
Bibliographic references :
Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003 Jan 30;348(5):383-93.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi
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