Diabetes Trial Files Throwback Thursday: Ramipril vs. Telmisartan vs. Both in CVD, Stroke, PAD, or DM, Intensive Glycemic Therapy in T2DM, and Canagliflozin in Diabetic Nephropathy
Telmisartan, Ramipril, or Both in Patients at High Risk for Vascular Events
The ONTARGET Investigators. NEJM (April 2008)
Bottom Line: This randomized, double-blind clinical trial compared the effects of ramipril, telmisartan, and combination therapy in patients with vascular disease or high-risk diabetes without heart failure. After a median follow-up of 56 months, telmisartan was found to be equivalent to ramipril in reducing the primary composite outcome of death from cardiovascular causes, myocardial infarction, stroke, or hospitalization for heart failure. Telmisartan also had lower rates of cough and angioedema, but higher rates of hypotensive symptoms compared to ramipril. Combination therapy did not provide additional benefit and had more adverse events. This study suggests that telmisartan may be a suitable alternative to ramipril for these patients, with a lower risk of angioedema. However, combination therapy should be used with caution due to the increased risk of adverse events.
Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)
UKPDS Group. The Lancet (September 1998)
Bottom Line: This randomized controlled trial compared the effects of intensive blood-glucose control with either sulphonylurea or insulin and conventional treatment on the risk of microvascular and macrovascular complications in newly diagnosed patients with type 2 diabetes. The study included 3867 participants with a median age of 54 years. The primary outcome was the risk of microvascular and macrovascular complications, with a 25% risk reduction in microvascular endpoints in the intensive group compared to the conventional group. Safety outcomes showed higher rates of hypoglycaemic episodes and weight gain in the intensive group. The conclusion was that intensive blood-glucose control with sulphonylureas or insulin can decrease the risk of microvascular complications in type 2 diabetes patients.
Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy
Perkovic V et al. NEJM (April 2019)
Bottom Line: This double-blind, randomized trial evaluated the effectiveness of canagliflozin, an oral SGLT2 inhibitor, in patients with type 2 diabetes and albuminuric chronic kidney disease. The intervention group received 100 mg of canagliflozin daily, while the comparator group received placebo. The primary outcome was a composite of end-stage kidney disease, a doubling of the serum creatinine level, or death from renal or cardiovascular causes at a median follow-up of 2.62 years. The study found that the canagliflozin group had a 30% lower risk of the primary outcome compared to the placebo group. Additionally, the canagliflozin group had a lower risk of cardiovascular death, myocardial infarction, or stroke, and hospitalization for heart failure. There were no significant differences in rates of amputation or fracture. This trial suggests that canagliflozin may be an effective treatment for patients with type 2 diabetes and kidney disease.
Diabetes Trial Files Issue #DIA-2025-02
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