Efficacy of intensive multitherapy for patients with type 2 diabetes mellitus: a randomized controlled trial.
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 A1c concentration of 8% or greater were randomly assigned to receive intensive multitherapy (n = 36) or usual care (n = 36).


RESULTS
The average hemoglobin A1c 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 < or = 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).


CONCLUSIONS
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.
Ménard
Julie
J
Diabetes and Metabolism Research Group, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada. julie.menard@chus.qc.ca
Payette
Hélène
H
Baillargeon
Jean-Patrice
JP
Maheux
Pierre
P
Lepage
Serge
S
Tessier
Daniel
D
Ardilouze
Jean-Luc
JL
D000328:Adult; D000368:Aged; D001786:Blood Glucose; D001794:Blood Pressure; D008078:Cholesterol, LDL / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000178:diet therapy / Q000628:therapy*; D050171:Dyslipidemias / Q000150:complications / Q000188:drug therapy; D002149:Energy Intake; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D005905:Glyburide / Q000627:therapeutic use; D006442:Glycated Hemoglobin; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006973:Hypertension / Q000150:complications; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011788:Quality of Life; D014280:Triglycerides / Q000097:blood
D001786:Blood Glucose; D008078:Cholesterol, LDL; D005905:Glyburide; D006442:Glycated Hemoglobin; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007004:Hypoglycemic Agents; D007328:Insulin; D014280:Triglycerides