Glycemic control and complications in type II diabetes: Design of a feasibility trial

Carlos Abraira, Nicholas Emanuele, John Colwell, William Henderson, John Comstock, Seymour Levin, Frank Nuttall, Clark Sawin

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

OBJECTIVE - To determine, after 1 yr of follow-up in type II diabetes patients, whether a statistically and clinically significant difference can be achieved in HbA1c between a standard therapy group and an intensively treated group, while maintaining HbA1c levels in both groups within ranges acceptable in regular community practice. Secondary objectives include assessment of patient adherence to protocol, side effects, and accuracy of data collection. RESEARCH DESIGN AND METHODS - This is a prospective, randomized, controlled VA CS conducted with 151 patients at five VAMCs. Patients are males, age 40-69 yr, treated at entry with a maximum dose of sulfonylurea or with insulin, exhibiting an HbA1c level >3 SDs above the normal mean (5.05 + 3 × 0.50 = >6.55%). Standard control is achieved with insulin and intensive control with a step-up regimen including insulin alone or insulin/glipizide combinations. Education and management of cardiovascular risk factors are handled similarly in both groups. Primary macrovascular end points are nonfatal myocardial infarction, congestive heart failure, stroke, amputation, and cardiovascular death. Primary microvascular end points are appearance and progression of retinopathy, documented by centrally read seven-field-stereo fundus photographs. Other measured indicators include resting and ambulatory ECGs, ventricular function (MUGA scan), serum lipid and apolipoprotein levels, plasma fibrinogen, nonsymptomatic peripheral vasculopathy, neuroautonomic status by heart-beat variation on Valsalva maneuver, and microalbuminuria. CONCLUSIONS - This study may be the basis for a long-term trial, involving 1400 patients, to assess the long-term effects of metabolic control on macroand microvascular end points.

Original languageEnglish
Pages (from-to)1560-1571
Number of pages12
JournalDiabetes Care
Volume15
Issue number11
StatePublished - Nov 1 1992

Fingerprint

Type 2 Diabetes Mellitus
Insulin
Myocardial Infarction
Glipizide
Valsalva Maneuver
Ventricular Function
Apolipoproteins
Patient Compliance
Group Psychotherapy
Amputation
Fibrinogen
Electrocardiography
Research Design
Heart Failure
Lipids
Education
Serum

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Abraira, C., Emanuele, N., Colwell, J., Henderson, W., Comstock, J., Levin, S., ... Sawin, C. (1992). Glycemic control and complications in type II diabetes: Design of a feasibility trial. Diabetes Care, 15(11), 1560-1571.

Glycemic control and complications in type II diabetes : Design of a feasibility trial. / Abraira, Carlos; Emanuele, Nicholas; Colwell, John; Henderson, William; Comstock, John; Levin, Seymour; Nuttall, Frank; Sawin, Clark.

In: Diabetes Care, Vol. 15, No. 11, 01.11.1992, p. 1560-1571.

Research output: Contribution to journalArticle

Abraira, C, Emanuele, N, Colwell, J, Henderson, W, Comstock, J, Levin, S, Nuttall, F & Sawin, C 1992, 'Glycemic control and complications in type II diabetes: Design of a feasibility trial', Diabetes Care, vol. 15, no. 11, pp. 1560-1571.
Abraira C, Emanuele N, Colwell J, Henderson W, Comstock J, Levin S et al. Glycemic control and complications in type II diabetes: Design of a feasibility trial. Diabetes Care. 1992 Nov 1;15(11):1560-1571.
Abraira, Carlos ; Emanuele, Nicholas ; Colwell, John ; Henderson, William ; Comstock, John ; Levin, Seymour ; Nuttall, Frank ; Sawin, Clark. / Glycemic control and complications in type II diabetes : Design of a feasibility trial. In: Diabetes Care. 1992 ; Vol. 15, No. 11. pp. 1560-1571.
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