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Diabetes Care. 1997 Mar;20(3):258-64.

Effect of intensive treatment of diabetes of the risk of death or renal failure in NIDDM and IDDM.

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  • 1Heart of America Diabetes Research Foundation, North Kansas City, MO 64116, USA.

Abstract

OBJECTIVE:

To examine the effectiveness and safety of long-term intensive therapy in NIDDM and IDDM.

RESEARCH DESIGN AND METHODS:

In a private practice setting with a multi-disciplinary team, we compared the rates of total mortality, cardiac-specific mortality, and severe renal failure over 14 years in a cohort of 780 eligible patients, 209 patients with a longer duration of intensive therapy (median duration > 11 years, group I) and 571 patients with shorter duration of intensive therapy (median duration < 1 year, group II). A comorbidity index was used to assess the degree of prognostic risk at baseline. A comprehensive diabetes program was the therapeutic intervention. The endocrinologists and diabetes care team provided primary care, aggressive cardiovascular screening, and risk reduction. Intensive insulin therapy was used in 95.7% of group I IDDM and 66.0% of group I NIDDM patients.

RESULTS:

The overall median HbA1c for group I was 7.3%. Compared with group II, the overall reduction in cumulative total mortality in group I was 22%. In the cohort with less severe initial comorbidity, the reduction in total mortality was 45%. We found similar reductions in renal failure rates in IDDM and in cardiac mortality in NIDDM patients on intensive insulin therapy.

CONCLUSIONS:

This comprehensive diabetes program is associated with lowered mortality and morbidity in both IDDM and NIDDM. Intensive insulin therapy in long-term patients with NIDDM does not increase cardiac mortality. Intensive therapy is safe and effective in NIDDM within the context of a comprehensive program.

PMID:
9051368
[PubMed - indexed for MEDLINE]
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