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Efficacy of intensive multitherapy for patients with type 2 diabetes mellitus: a randomized controlled trial

From the Diabetes and Metabolism Research Group (Ménard, Baillargeon, Maheux, Tessier, Ardilouze) and the Cardiology Unit, Clinical Research Centre (Lepage), Centre Hospitalier Universitaire de Sherbrooke, and the Research Centre on Aging (Payette, Tessier), Sherbrooke Geriatric University Institute, Sherbrooke, Qué.

Correspondence to: Dr. Julie Ménard, Centre Hospitalier Universitaire de Sherbrooke, Clinical Research Centre, 3001 12th Ave. N., Sherbrooke QC J1H 5N4, julie.menard{at}chus.qc.ca

Abstract

Background: 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.

Methods: 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 A_1c concentration of 8% or greater were randomly assigned to receive intensive multitherapy (n = 36) or usual care (n = 36).

Results: The average hemoglobin A_1c 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 A_1c 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:high-density 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).

Interpretation: 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.

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				J. Menard and J.-L. Ardilouze Multitherapy for diabetes Can. Med. Assoc. J., November 7, 2006; 175(10): 1247 - 1247. [Full Text] [PDF]

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