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Treatment of Type 2 Diabetics with Heart Disease


The results of a study designed to reflect how physicians might confront diabetes treatment decisions in practice has been presented at the American Diabetes Association 69th Scientific Sessions and published online on 7 June in the New England Journal of Medicine, NEJM. The international landmark study found that death rates for patients with both type 2 diabetes and heart disease was the same whether they received drugs or had prompt surgery or angioplasty. It was also noted that the risk of a further major cardiac event was lowered when diabetes patients with more severe heart disease had prompt bypass surgery.

The BARI 2D study (Bypass Angioplasty Revascularization Investigation 2 Diabetes) started in 2001. It involved 2,368 patients (4,623 were screened, but 2187 were found to be ineligible for various reasons) who had both type 2 diabetes and stable heart disease and who were being treated by their doctor for cholesterol and blood pressure. These patients were randomly assigned into one of two groups. One group received drugs and underwent prompt surgery to restore blood flow by either angioplasty or bypass surgery. The second group just received drugs.

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The researchers believe their findings will provide much needed guidance on how to provide treatment for diabetes patients with heart disease.

Diabetes Treatment for Heart Disease Patients Key Points

  • No significant difference was found in survival between those who received insulin (87.9 per cent) and those who had drugs to reduce insulin resistance (88.2 per cent).
  • 5-year survival rates did not differ significantly between the surgery with drugs group (88.3 per cent) and the drugs only group (87.8 per cent).
  • The bypass surgery group had fewer major cardiovascular events such as heart attacks, stroke and deaths (22.4 per cent) than the drugs only group (30.5 per cent).

"A Randomized Trial of Therapies for Type 2 Diabetes and Coronary Artery Disease. The BARI 2D Study Group.
N Engl J Med Published online 7 June 2009. (DOI: 10.1056/NEJMoa0805796)