Rate of overall survival and freedom from cardiovascular (CV) events of Type 2 diabetes patients with ischemic heart disease (IHD) does not differ significantly between patients treated with revascularization versus intensive medical therapy, show results from the BARI 2D trial.

Similarly, the researchers found no significant differences between mortality and CV event rate between those treated with insulin provision versus insulin sensitization strategies.

“Few large, randomized trials have addressed the question of the optimal treatment for patients with diabetes and angiographically defined stable ischemic heart disease,” comment Maria Brooks (University of Pittsburgh, Philadelphia, USA) and co-researchers in the New England Journal of Medicine.

The BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial enrolled 2368 patients with Type 2 diabetes and IHD between January 2001 and March 2005. Patients were followed up for an average period of 5 years.

Participants were sorted into two revascularization groups by their individual suitability for percutaneous coronary intervention (PCI, n=1605) versus coronary artery bypass graft (CABG, n=763).

The CABG group were then randomly assigned to receive CABG (n=378) or intensive medical therapy including statins, aspirin, and beta-blockers (n=385), and the PCI group to receive PCI (n=798) or intensive medical therapy (n=807). A further round of randomization was then carried out to assign participants to either insulin provision (n=1185) or insulin sensitization (n=1183) therapy.

At 5 years, rates of survival were 88.3% in the revascularization group and 87.8% in the intensive medical therapy group, a non-significant difference.

Survival was also non-significantly different between patients taking insulin provision or insulin sensitization therapy at 87.9% and 88.2%, respectively.

Rates of freedom from CV events (CV death, myocardial infarction, or stroke) were also similar at 77.2%, 75.9%, 77.7%, and 75.4% in the revascularization, intensive medical therapy, insulin sensitization, and insulin provision groups, respectively.

When the researchers assessed the results by type of revascularization, they found no significant difference in outcomes between patients who had PCI versus intensive medical therapy. However, they found that significantly less patients who underwent CABG had major CV events compared with those on intensive medical therapy at 22.4% versus 30.5%, largely driven by a greater reduction in nonfatal myocardial infarction.

Brooks et al note that adverse events were generally similar across the different groups, but that severe hypoglycemia was more common in the insulin provision group compared with the insulin sensitization group at 9.2% versus 5.9%. Insulin sensitization therapy also seemed to provide more significant improvements in plasma insulin, glycated hemoglobin, high-density lipoprotein cholesterol, and weight gain than insulin provision therapy.

“Overall, the BARI 2D results reassure us that our current major drug treatments for diabetes are equally appropriate,” said study author Saul Genuth (Case Western Reserve University, Cleveland, Ohio, USA).

“They also indicate that when a patient with Type 2 diabetes has more severe heart disease it may be better to do bypass surgery early than to wait and simply treat with medication. For patients with milder disease who are candidates for angioplasty, it is appropriate to treat with drug therapy first.”

The results from the BARI 2D trial were presented at the American Diabetes Association 69th Scientific Sessions held in New Orleans, Louisiana.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

Free abstract

Treating diabetes is hard enough. Don’t make it harder by starving your body of the nutrients it needs to work properly. Research has shown decisive evidence supporting key vitamins for hypoglycemia can dramatically improve your success against this disease.

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Hypoglycemia is low blood sugar, and it leads to type II diabetes. Diabetes is a medical snowball that can deplete your health rapidly. Left unchecked, diabetes can lead to feet/leg amputations and heart disease. Without going into great detail, you would be wise to protect your health and your heart with preventative measures. Vitamins for hypoglycemia exist, and they are proven to be effective.

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Research has shown that insulin sensitivity (hypoglycemia) is influenced by many different dietary factors. Proper nutrition plays a vital role in controlling blood glucose levels and insulin function throughout our life.

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Individuals with poor blood sugar metabolism are more susceptible to free radicals that speed up the aging process and promote chronic illnesses like cancer, stroke, and heart disease. Antioxidants can neutralize these free radicals protecting you from the aging process, but unfortunately, diabetics have low levels of antioxidants. This is a main reason the life expectancy of a diabetic person is reduced. A potent antioxidant is recommended by doctors to help neutralize free radicals, but this is not the only supplementation that is helpful.

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Diabetics have low blood levels of copper, zinc, selenium and especially chromium. These nutrients are an integral part of the glucose tolerance factor (GTF), that is essential for proper glucose metabolism. Supplementing with these key nutrients at optimum doses can make dramatic improvements in your health. Diabetes is not easy to live with, but a little education goes a long way.

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Without getting technical and wordy, it is important to give your body what it needs to function properly. There are supplements available that are specifically designed to target the needs and deficiencies of diabetes. Vitamins for hypoglycemia work and they are inexpensive. Improve your quality of life with expert advice from the Superfood-Guru. Life’s Delicious!

If you are diabetic selecting the correct foods can seem to be a challenge on occasions, however with a proper meal plan and some practice this will become second nature to you.

Your meal plan is your guide to healthy eating. A registered dietician or your diabetic health worker/nurse should be able to assist you in your diet plan.

Before you go to the supermarket write down your list of healthy foods that you require for the week. Select some or all of the following, whole grains, fresh,frozen and canned fruit and vegetables. If you select fruit in cans make sure they are packed in water or fruit juice, and that your vegetables are without added salt or sauces.

Select lean cuts of meat, skinless poultry or remove the skin yourself, use fat free/semi skimmed milk, plain yoghurt, and reduced or low fat cheese. Check all labels for the nutritional value, fat, sugar and salt content of your purchases, consider health options before taste.

Only buy light or fat free mayonnaise or salad cream, and if you are trying to lose weight don’t forget that fat and sugar free foods still contain calories. If time is an issue most supermarkets stock foods which are suitable for diabetics just ask, and check out the ready prepared meals from weight watchers and other weight loss groups.

Where possible bake,steam, grill and boil your foods, try to keep using lard/butter in your cooking to a minimum. If you must use a sweetener avoid sugar and use a low calorie sweetener that’s suitable for baking.

Read recipe books on meals for diabetics and learn a few insider methods for example: when mashing potatoes use skimmed milk and a brand of “light” margarine in place of ordinary milk and butter. For a change use mashed cauliflower in place of potatoes. How about having a light snack say 90 or 60 minutes before your meal so you don’t require as much to eat, say an apple with a slice of low fat cheese, or a couple of cream crackers with perhaps a little boiled ham on them. Keep to your plan stay within the calorie/carbohydrates guidelines you will lose weight and remain healthy.