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Clinical Question:
Is Intensive multitherapy for patients with poorly
controlled type 2 diabetes effective in helping patients
meet most of the goals set by a national diabetes association?
Bottom Line:
Intensive multitherapy for patients with poorly
controlled type 2 diabetes is successful in helping patients
meet most of the goals set by a national diabetes association.
However, 6 months after intensive therapy stopped and patients
returned to usual care, the benefits had vanished.
Reference:
Efficacy of intensive multitherapy for patients with type 2 diabetes
mellitus: a randomized controlled trial.Menard J, Payette H, Baillargeon JP,
Maheux P, Lepage S, Tessier D, Ardilouze JL.CMAJ. 2005 Nov 17; [Epub ahead
of print]
Study Design:
Randomized Controlled Trial
Synopsis:
National guidelines for managing diabetes set standards for care. We sought
to determine whether a 1-year intensive multitherapy program resulted in
greater goal attainment than usual care among patients with poorly
controlled type 2 diabetes mellitus.We identified patients with poorly
controlled type 2 diabetes receiving outpatient care in the community or at
our hospital. Patients 30?70 years of age with a hemoglobin A1c
concentration of 8% or greater were randomly assigned to receive intensive
multitherapy (n = 36) or usual care (n = 36). The average hemoglobin A1c
concentration at entry was 9.1% (standard deviation [SD] 1%) in the
intensive therapy group and 9.3% (SD 1%) in the usual therapy group. By 12
months, a higher proportion of patients in the intensive therapy group than
in the control group had achieved Canadian Diabetes Association (CDA) goals
for hemoglobin A1c concentrations (goal ? 7.0%: 35% v. 8%), diastolic blood
pressure (goal < 80 mm Hg: 64% v. 37%), low-density lipoprotein cholesterol
(LDL-C) levels (goal < 2.5 mmol/L: 53% v. 20%) and triglyceride levels (goal
< 1.5 mmol/L: 44% v. 14%). There were no significant differences between the
2 groups in attaining the targets for fasting plasma glucose levels,
systolic blood pressure or total cholesterol:highdensity lipoprotein
cholesterol ratio. None of the patients reached all CDA treatment goals. By
18 months, differences in goal attainment were no longer evident between the
2 groups, except for LDL-C levels. Quality of life, as measured by a
specific questionnaire, increased in both groups, with a greater increase in
the intensive therapy group (13% [SD 10%] v. 6% [SD 13%], p < 0.003). |