Effect of intensive treatment of diabetes of the risk of death or renal failure in NIDDM and IDDM.
OBJECTIVE
To examine the effectiveness and safety of long-term intensive therapy in NIDDM and IDDM.


METHODS
In a private practice setting with a multi-disciplinary team, we compared the rates of total mortality, cardiac-specific mortality, and severe renal failure over 14 years in a cohort of 780 eligible patients, 209 patients with a longer duration of intensive therapy (median duration > 11 years, group I) and 571 patients with shorter duration of intensive therapy (median duration < 1 year, group II). A comorbidity index was used to assess the degree of prognostic risk at baseline. A comprehensive diabetes program was the therapeutic intervention. The endocrinologists and diabetes care team provided primary care, aggressive cardiovascular screening, and risk reduction. Intensive insulin therapy was used in 95.7% of group I IDDM and 66.0% of group I NIDDM patients.


RESULTS
The overall median HbA1c for group I was 7.3%. Compared with group II, the overall reduction in cumulative total mortality in group I was 22%. In the cohort with less severe initial comorbidity, the reduction in total mortality was 45%. We found similar reductions in renal failure rates in IDDM and in cardiac mortality in NIDDM patients on intensive insulin therapy.


CONCLUSIONS
This comprehensive diabetes program is associated with lowered mortality and morbidity in both IDDM and NIDDM. Intensive insulin therapy in long-term patients with NIDDM does not increase cardiac mortality. Intensive therapy is safe and effective in NIDDM within the context of a comprehensive program.
Hellman
R
R
Heart of America Diabetes Research Foundation, North Kansas City, MO 64116, USA.
Regan
J
J
Rosen
H
H
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000208:ethnology / Q000401:mortality*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy / Q000208:ethnology / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000208:ethnology / Q000401:mortality; D003925:Diabetic Angiopathies / Q000401:mortality*; D003928:Diabetic Nephropathies / Q000401:mortality*; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006331:Heart Diseases / Q000401:mortality*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012016:Reference Values; D051437:Renal Insufficiency / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin