Long-term Diabetes Complications and Intensive Treatment Effects

Compared with routine care, early intensive multifactorial therapy shows little effect…. 

In an effort to determine the benefit of multifactorial treatment on microvascular complications among people with type 2 diabetes, Annelli Sandbaek, MD, PhD, and colleagues conducted a multicenter cluster randomized controlled trial at four centers in Denmark, the UK, and The Netherlands. Out of 3,057 people with diabetes detected by a screening process, only 2,861 were eligible for follow-ups. They were assigned to either the intensive treatment or routine care group.

The results from the four centers were collected using a fixed-effects meta-analysis. Of the patients who received intensive treatment, 22.7% showed any type of albuminuria, and patients who underwent routine care had 24.4%. Retinopathy was observed in 10.2% of the patients who underwent intensive treatment, whereas 12.1% was seen in routine care patients. When it came to neuropathy, 4.9% was seen in intensive treatment patients, and 5.9% in routine care patients. However, in both groups the estimated glomerular filtration rate increased between baseline and follow-up; 4.31 mL/min was seen in the intensive treatment and 6.44 mL/min in the routine care groups.

According to the results of this study, researchers stated, "Compared with routine care, an intervention to promote target-driven, intensive management of patients with type 2 diabetes detected by screening was not associated with significant reductions in the frequency of microvascular events at five years."

• Albuminuria was 22.7% in the intensive group compared to 24% in the routine care group.
• Retinopathy was present in 10.2% of the patients who underwent intensive treatment, whereas 12.1% was seen in routine care patients
• Neuropathy, 4.9%, was seen in intensive treatment patients, and 5.9% in routine care

Sandbaek A et al. Diabetes Care. 2014; doi: 10.2337/dc13-1544