- Intensive therapy for type 2
diabetes with microalbuminuria found to be effective.
- It increases median lifespan by 8
- First cardiovascular event noticed
only after 8 years.
- 30-50% reduction in complications
in the eyes and kidneys.
Scientists carried out a long-term
follow-up study in a Danish population to understand the importance of
intensive treatment for type 2 diabetes patients who had microalbuminuria. The
study revealed that intensive therapy for type II diabetes
patients with albuminuria showed
a significant increase in life span when compared with type II diabetes
patients who received traditional methods of treatment.
One of the two first authors of the study,
Dr. Peter Gaede from The University of South Denmark says "The outcome of
our study is very encouraging and emphasizes the need for early and intensified
treatment of multiple modifiable risk factors for a poor prognosis of patients
with type 2 diabetes."
‘Low fat and green diet, exercise and the right medication increase lifespan of type II diabetes patients by 8 years.’
Type II Diabetes
In patients with type II diabetes, insulin
, that is responsible for the uptake of blood
sugar into fat, liver and muscle cells, does not function well. This results in
a build-up of blood sugar and an inability of the fat, muscle and liver cells
to take up the blood sugar and to store it as energy.
This disease is gaining in incidence with
many people affected. People who are overweight or obese are prone to
and it is aptly called a lifestyle disease.
The build-up of blood sugar is called
hyperglycemia and, initially, the pancreas will produce more insulin to lower
the blood sugar but, over time, the production of insulin by the pancreas is
lowered. The conditions that arise due to this are:
- Lack of energy in the cells
- Build up of sugar in the blood
- Increased blood lipids
- Increased aggregation of the platelets
in the blood
- Increased blood pressure
These conditions could affect kidneys, eyes,
heart and lead to classical symptoms of diabetes.
Symptoms of Type II diabetes
Diabetes is considered a silent killer as the
symptoms are not very evident or can easily be mistaken for a common condition.
The following are some of the symptoms of this disease
- Blurred vision.
- Frequent urination.
- Increased thirst.
- Increased hunger
- Frequent infection of the skin and
kidney that take time to heal.
Some patients with type II diabetes also
excrete some albumin in the urine called microalbuminuria which, when left
untreated, can increase the risk of cardiovascular disease and lead to
Management of Diabetes
The primary goal in managing type II diabetes
is to lower the blood sugar levels and as this disease is considered a
lifestyle disease, there are changes to the lifestyle
that are recommended.
However, patients rarely adhere to these modifications which have motivated
researchers to study the difference in treatment methodologies and to record
the effect on the lifespan of the patients.
Steno-2 was a well publicized study that
studied the effect of intensified treatment for diabetes with standard
intervention strategies for a period of 8 years among people with type II
diabetes and microalbuminuria.
Lead senior author of the study Dr. Oluf
Pedersen says "During recent years international and national guidelines
for improved care of patients with type 2 diabetes have generally adapted the
experiences and knowledge gained from multiple single-risk factor interventions
(e.g. treating blood
alone, blood lipids alone, or elevated blood pressure alone)
and the previously reported intervention outcomes of the multifactorial Steno-2
study. In parallel and excitingly, recent epidemiological surveys now report on
a decline in diabetes mortality in several parts of the world. The observations
from the 21 years of follow-up of the Steno-2 study are another important
contribution to justify an early, intensified, individualised and multifaceted
care of patients with type 2 diabetes".
Development of Complication in Type II
In an earlier follow up of the Steno-2 study
of type II diabetes patients with microalbuminuria, the study authors analyzed
the effectiveness of intensive treatment strategies against the standardized
strategies to understand the implication on heart, eyes, kidney, legs and the
Dr. Jens Oellgaard the co-author of the study
says about the result of the previous study "In previous reports from the
Steno-2 study we have demonstrated the unprecedented efficacy of this
structured multifactorial intervention where development of complications in
the eyes, kidneys, legs, heart and brain is halved compared with conventional
Individuals who have type II diabetes along
with microalbuminuria have a lower lifespan and the researchers followed up on
the Steno-2 study to identify difference in lifespan among patients who
received intensive treatment and patients who received standardized treatment.
Intensive Treatment Group
The study group that received intensive
treatment benefited from the following:
Conventional Therapy Group
- The study was conducted in a
- Low fat and green diet
- Increased exercises that were
- Instructions provided to quit
- Drugs provided for
- Blood glucose
- Blood pressure
- Blood platelet
- Blood lipids
The patients in this group were treated
according to the guidelines prescribed by diabetes care. They received medical
care from general practitioners and were referred to specialists when there was
The study continued for 8 years and 160
patients in the intensive study group were made to follow the same guidelines
for 13 years after that.
Results of the Study
At the end of 21 years from the start of
the study, the following results were recorded:
- 38 patients in the intensive
therapy group died
- 55 patients from the conventional
- Patients in the intensive therapy
group lived a median of 8 years longer.
- The median time taken for the
first cardiovascular event was found to be 8 years for patients in the
intensive therapy group.
- There was a 30-50% reduction in
the risk of complications to the eyes and kidneys among patients in the intensive therapy
This is a landmark study that will
significantly improve prognosis of patients with type II diabetes and
microalbuminuria. There have been many studies that have looked at diabetes
management from specific angles like lifestyle modification and better medications
, however, this study focuses on
including all these aspects in providing effective therapy. This effective
therapy improved lifespan as well as the quality of life by lowering the risk
of a cardiovascular event and complications in the eyes and kidneys.
As senior author Dr. Hans-Henrik Parving adds
"This long-term follow-up of the Steno-2 study demonstrates beyond any
doubt the sustainability of the intensified and multipronged treatment approach
of type 2 diabetes patients with microalbuminuria introduced by us more than 21
years ago. The benefits for the patients in terms of a major extension of life
and a halving of new cardiovascular complications speak for themselves."
- Type 2 Diabetes Facts - (http://www.diabetes.org/diabetes-basics/type-2/facts-about-type-2.html)
- Type 2 Diabetes - (https:medlineplus.gov/ency/article/000313.htm)