番茄社区

ORLANDO – A long-term study suggested that intensive therapy for diabetes not only extended survival compared with conventional treatment, but the cost was no higher in terms of medical resources, researchers reported here.

While there were clear advantages for the intensive treatment in preventing complications and death, the medical costs were very similar between the two groups, Joachim Gaede, a third-year medical student at the University of Copenhagen, said at a press conference at the . The cost per patient-year of life was €8,172 ($9,555) in the intensive-care group and €9,047 ($10,576) in the conventional-care group. The difference of €875 ($1,023) was not statistically significant (P=0.2).

"Basically, the intensified treatment tends to use more medication, especially cholesterol-lowering treatment, diabetes medications, and anti-platelet medication," he told 番茄社区. "The intensified treatment had strict targets for cholesterol, blood pressure, and other conditions."

The primary analysis covered the years 1993-2014. A sensitivity analysis performed for the years 1996-2014 when registry data was more accurate did not substantially alter the outcomes, he said, although for the per-patient direct medical costs there was an actual reduction on costs for the intensified therapy -- a reduction of €1,366 ($1,597) per patient year of life.

"The key point of this study [called Steno 2] is that an intensified multifactorial approach to treatment of type 2 diabetes increased the lifespan of patients by a median of 7.9 years without any additional healthcare costs over 21.2 years of follow-up."

Gaede acknowledged that although the cost numbers might be different in countries other than Denmark, the overall conclusion would be the same.

The compared a conventional multifactorial treatment conducted at a family clinic with intensified treatment conducted at a specialized diabetes clinic. The study started in 1993 – when Joachim Gaede was 1 year old -- with his father, Peter Gaede, MD, of the University of Southern Denmark/Slagelse Hospital, and other colleagues enrolling 160 patients. The participants had been diagnosed with diabetes and already were showing signs of organ damage, manifested through the appearance of microalbuminuria.

The intensified treatment was aimed at having patients reach strict treatment goals in line with current ADA guidelines, focusing on intensified pharmaceutical interventions but also on lifestyle interventions such as smoking cessation and diet.

At 4 years after the trial, the researchers analyzed outcomes based on damage to kidneys, eyes, and nerves, and reported, in a 1999 study, a 50% relative risk reduction in kidney eye and nerve complications. At 8 years, the Steno-2 trial group reported a 53% relative risk reduction in myocardial infarction, stroke, and amputation -- a 20% absolute risk reduction -- among the patients in the intensive care treatment arm. At that point, with the benefits of intensified treatment realized, all patients were offered the intensified therapy.

A 46% relative risk reduction in death was observed after 13 years -- also a 20% absolute risk reduction.

After reviewing the data with 21 years of follow-up, the researchers reported that the intensified treatment resulted in 7.9 years of life gained. After 21 years, 24 patients of the original 80 in the conventional treatment group remained alive, compared with 42 of the 80 patients originally assigned to the intensive treatment.

"Diabetes is associated with a 12-year life-shortening experience because of cardiovascular disease and many other complications," said press conference moderator Robert Eckel, MD, of the University of Colorado Anschutz Medical Campus in Aurora.

He said that he doesn't believe that doctors in the United States pursue treatment that would qualify as the intensified therapy as outlined in the Danish trial: "I don't think doctors here prescribe as aggressively as they should," he told 番茄社区. "I think the primary care physician needs to be informed about the guidelines. Multifactorial studies such as Steno-2 haven't been done in the United States. We can learn from this experience."

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