Rationale, design, and methods for glycemic control in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Trial.
A major therapeutic question in considering accelerated atherogenesis in patients with type 2 diabetes mellitus is whether reducing insulin resistance, as a proximal defect of a host of proatherogenic abnormalities including hyperglycemia, will be superior for decreasing mortality and coronary artery disease (CAD) risk compared with treating hyperglycemia to overcome insulin resistance with insulin-providing agents. This question is highly relevant, since earlier targeted glycemic control trials utilizing conventional glucose-lowering strategies that increase insulin levels have generally failed to reduce CAD risk despite markedly reducing microvascular risk. The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial seeks to determine whether primarily using an insulin-sensitizing strategy for treatment of type 2 diabetes is superior when compared with primarily using an insulin-providing strategy with regard to cardiovascular outcomes. This article presents the rationale, design, and methods being used to test the glycemic control hypothesis in BARI 2D.
Magee
Michelle F
MF
MedStar Diabetes Institute, MedStar Research Institute at Washington Hospital Center and Georgetown University Hospital, Washington, DC 20010, USA. michelle.f.magee@medstar.net
Isley
William L
WL
D000465:Algorithms; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications / Q000628:therapy*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000628:therapy*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications / Q000628:therapy; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D009204:Myocardial Revascularization; D016032:Randomized Controlled Trials as Topic; D012107:Research Design
D007004:Hypoglycemic Agents