Diabetes Trial Files Throwback Thursday: Intensive BP Control in T2DM, Metformin and Intensive Lifestyle in Prediabetes, and CABG vs. PCI for CAD in T2DM
Effects of Intensive Blood-Pressure Control in Type 2 Diabetes Mellitus
ACCORD Study Group. NEJM (April 2010)
Bottom Line: This randomized trial investigated the effects of lowering systolic blood pressure to below 120 mm Hg in patients with type 2 diabetes at high risk for cardiovascular events. A total of 4733 participants were assigned to either intensive therapy targeting a systolic pressure of less than 120 mm Hg or standard therapy targeting a systolic pressure of less than 140 mm Hg. After 4.7 years of follow-up, there was no significant difference in the primary outcome of nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes between the two groups. However, the intervention group did have a lower rate of stroke. Serious adverse events attributed to antihypertensive treatment were more common in the intervention group. In conclusion, targeting a systolic blood pressure of less than 120 mm Hg did not reduce the rate of major cardiovascular events in this patient population.
Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin
DPP Research Group. NEJM (February 2002)
Bottom Line: This randomized controlled trial aimed to determine the effectiveness of lifestyle changes and metformin treatment in preventing or delaying the development of type 2 diabetes in high-risk individuals. A total of 3234 nondiabetic participants with elevated plasma glucose concentrations were randomly assigned to receive placebo, metformin, or a lifestyle-modification program. The average follow-up was 2.8 years, and the primary outcome was the incidence of diabetes. The lifestyle intervention was found to be significantly more effective than metformin, with a 58% reduction in incidence compared to a 31% reduction with metformin. The study concluded that for every 6.9 individuals participating in the lifestyle intervention, one case of diabetes could be prevented in a period of three years.
Strategies for Multivessel Revascularization in Patients with Diabetes
Farkouh ME et al. NEJM (December 2012)
Bottom Line: This randomized trial compared the use of drug-eluting stents and coronary-artery bypass grafting (CABG) for patients with diabetes and multivessel coronary artery disease. 1900 patients were enrolled and followed for a minimum of 2 years. The primary outcome was a composite of death from any cause, nonfatal myocardial infarction, or nonfatal stroke. The primary outcome occurred more frequently in the PCI group, with 5-year rates of 26.6% compared to 18.7% in the CABG group. The benefit of CABG was driven by differences in rates of both myocardial infarction and death from any cause. However, stroke was more frequent in the CABG group. In conclusion, for patients with diabetes and advanced coronary artery disease, CABG was superior to PCI in reducing rates of death and myocardial infarction, with a higher rate of stroke.
Diabetes Trial Files Issue #DIA-2025-06
Want to view past issues? Visit our archive:
