This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Steno-2 study in type 2 diabetes (with microalbuminuria)

Authoring team

The concept of a polypill in diabetes is supported by the Steno-2 study in which multiple risk factors were targetted and resulted in the intervention group having a signicant reduction in incidence of cardiovascular disease (1)

  • study involved 160 high-risk type 2 diabetic patients with microalbuminuria aged 55.1 years (average), who were randomly assigned to a conventional or an intensive, multifactorial intervention for a period of 7.8 years
    • in the intensive group, a stepwise treatment plan was adopted involving both continuous lifestyle education and motivation and an ambitious goal-oriented pharmacological treatment of known modifiable risk factors
      • patients were to follow a reduced-fat diet and exercise regularly, offered smoking cessation counseling, prescribed an angiotensin-converting enzyme (ACE) inhibitor or angiotensin II–receptor blockers (ARB) regardless of blood pressure, and received vitamin supplementation and aspirin
        • stepwise antiglycaemic and antihypertension medications were also prescribed as well as lipid-modifying therapy with a statin and/or fibrate
        • subjects receiving intensive therapy were much more likely to reach their total cholesterol goal (<175 mg/dl (4.5 mmol/l)) and systolic blood pressure goal (<130 mm Hg) and to routinely use angiotensin-converting enzyme (ACE) inhibitors or angiotensin II–receptor blockers (ARBs)
    • the conventional group was treated in accordance with national guidelines for type 2 diabetes with less stringent goals
    • results revealed:
      • in the intensive treatment group: lower systolic and diastolic blood pressures, hemoglobin A(1c) (HbA(1c)), fasting serum total and low-density lipoprotein (LDL) cholesterol, fasting serum triglycerides, and 24-hour urine albumin excretion, as well as increased carbohydrate and decreased fat intake as percentage of total energy
      • there was no difference in weight gain between groups during follow-up and no other major side effects were reported
      • the primary end point was a macrovascular outcome: a composite of death from cardiovascular causes, nonfatal myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention, nonfatal stroke, amputation for ischemia, or vascular surgery for peripheral arterial atherosclerosis
      • the differences between groups in surrogate end points translated into the following significant group differences in final clinical end points:
        • 44% of patients in the conventional group had a cardiovascular event compared with 24% in the intensive group, ie, a relative risk reduction of about 50%
        • the relative risk of nephropathy, retinopathy, and autonomic neuropathy (secondary end points) was diminished by about 60% in the intensively treated group
    • the study authors concluded that, an intensified and goal-oriented multipronged approach to the treatment of type 2 diabetes reduces cardiovascular events, as well as nephropathy, retinopathy, and autonomic neuropathy, by about half

Reference:

  1. Metabolism. 2003 Aug;52(8 Suppl 1):19-23.

Create an account to add page annotations

Add information to this page that would be handy to have on hand during a consultation, such as a web address or phone number. This information will always be displayed when you visit this page

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.