title: Long-term effects intensive medical therapy on the development and progression of subclinical atherosclerosis and the metabolic syndrome in Chinese patients with type 2 diabetes mellitus.
abstract: BACKGROUND
  Few studies have investigated the progression of subclinical atherosclerosis and metabolic syndrome (MetS) in Chinese patients with type 2 diabetes mellitus (T2DM). This study was to compare the long-term effects of intensive medical therapy on the development and progression of subclinical atherosclerosis and MetS in Chinese T2DM patients with that of a conventional treatment regimen.
  
  
  METHODS
  A total of 316 T2DM patients were randomized to receive conventional pharmacological treatment or intensive medical therapy, consisting of diet and exercise counseling, from 2002 to 2014 at our hospital in Changsha, China. Clinical indicators of subclinical atherosclerosis and MetS were evaluated over the 12-year follow-up period. A χ analysis or t tests was used to compare the data between the 2 groups. Risk factors for subclinical atherosclerosis were identified using Cox proportional hazard models.
  
  
  RESULTS
  The incidence of subclinical atherosclerosis increased in both groups over time, and did not differ significantly between the 2 groups at the end of the study. However, after 6 years of treatment, the risk of subclinical atherosclerosis was significantly lower in the intensive medical therapy group, based on intima-media thickness (IMT) measurements, compared with that in the conventional treatment (44.2% vs. 69.7%; P < 0.01). Age, creatinine, and IMT of the common iliac artery were significantly associated with subclinical atherosclerosis. Although the indicators of MetS did not differ significantly at the end of study, the success rate for the management of MetS in the intensive medical therapy group was significantly higher than that in the conventional treatment group in 2006, 2008, 2010, and 2012.
  
  
  CONCLUSIONS
  The incidence of atherosclerosis in the intensive medical therapy group was significantly lower than that in the conventional treatment group from 2006 to 2010 (P < 0.05), and the incidence of MetS in the intensive medical therapy group was significantly higher than that in the conventional treatment group from 2006 to 2012. Kaplan-Meier estimations showed that the risk of subclinical atherosclerosis in the intensive medical therapy group was significantly lower than that in the conventional treatment group (P < 0.001), whereas the risk of MetS was not significantly different between the treatment groups (P > 0.05).
authors.affiliation: Department of Endocrinology, Xuhui District Central Hospital, Shanghai Department of Endocrinology B-Ultrasound Room, Second Xiangya Hospital of Central South University, Changsha, China.
authors.forename: Zhiwen
authors.initials: Z
authors.lastname: Liu
authors.forename: Zhiguang
authors.initials: Z
authors.lastname: Zhou
authors.forename: Gan
authors.initials: G
authors.lastname: Huang
authors.forename: Yang
authors.initials: Y
authors.lastname: Xiao
authors.forename: Zhen
authors.initials: Z
authors.lastname: Li
authors.forename: Cong
authors.initials: C
authors.lastname: Liu
authors.forename: Risu
authors.initials: R
authors.lastname: Na
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000453:epidemiology / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000628:therapy*; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome