ADA: Medicines Compared to Surgery in Diabetic Heart Disease

Survival is the same in patients who undergo revascularization or receive medical therapy
By Rick Ansorge
HealthDay Reporter

MONDAY, June 8 (HealthDay News) -- In patients with type 2 diabetes and coronary artery disease, various treatment strategies result in a similar survival outcome. However, when revascularization is indicated, coronary-artery bypass grafting (CABG) may be associated with a lower risk of major cardiac events than optimal medical therapy alone, according to a study published online June 7 in the New England Journal of Medicine to coincide with a presentation at the American Diabetes Association's 69th Scientific Sessions, held from June 5 to 9 in New Orleans.

Robert L. Frye, M.D., of the Mayo Clinic in Rochester, Minn., and colleagues from the BARI 2D Study Group randomly assigned 2,368 patients to two treatment strategies in a two-by-two factorial design. In the first strategy, patients received either prompt coronary revascularization or medical therapy. In the second strategy, they received either insulin-sensitization therapy or insulin-provision therapy to reach a glycated hemoglobin level of less than 7 percent.

After five years, the researchers found no evidence for their hypotheses that prompt revascularization and insulin sensitization would be the superior strategies. There were no significant group differences in the primary outcome -- death from any cause. However, they found that the patients who underwent CABG, but not percutaneous coronary intervention, had fewer major cardiac events than those who received medical therapy; and that those who received insulin-sensitization therapy were less likely than those who received insulin to reach the secondary composite end point of death, myocardial infarction, or stroke.

"BARI 2D shows that for many patients with both diabetes and coronary disease, optimal medical therapy rather than any intervention is an excellent first-line strategy, particularly for those with less severe disease," wrote the authors of an accompanying editorial.

This study was partially supported by 16 pharmaceutical companies; several authors reported financial relationships with one or more of the companies.

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