BARI 2D:2型糖尿病冠動脈疾患治療戦略トライアル:積極的冠動脈治療・インスリン治療戦略により差無し

BARI 2D研究:

A Randomized Trial of Therapies for Type 2 Diabetes and Coronary Artery Disease
The BARI 2D Study Group June 7, 2009 (10.1056/NEJMoa0805796)


即時血管再建+強化薬物治療 or 強化薬物治療単独
インスリン抵抗性改善治療 or インスリン負荷治療



・血管再建群:88.3% vs 薬物治療群:87.8% P=0.97
・インスリン感受性改善群:88.2% vs インスリン治療群:87.9%  P=0.89

・血管再建群:77.2% vs 薬物治療群:75.9% P=0.70
・インスリン感受性改善群:77.7% vs インスリン治療群:75.4%  P=0.13



だが、重大低血糖はインスリン治療群の方がインスリン感受性治療群より多かった (5.9%, P=0.003)



インスリン負荷治療群Drug: Insulin, sulfonylurea
インスリン感受性改善治療群Drug: Biguanides, thiazolidinediones

Although previous studies have shown a beneficial effect on cardiovascular outcomes associated with the use of insulin sensitization with thiazolidinediones and metformin, our results cannot distinguish between the effect of either agent or the combination.

In our study, plasma insulin levels were consistently lower over time in patients in the insulin-sensitization group (median, 6.3 µU per milliliter) than in those in the insulin-provision group (median, 10.0 µU per milliliter), a finding that is consistent with the mechanisms of action of metformin and thiazolidinediones. Despite the need to administer insulin or sulfonylureas to some patients, patients in the insulin-sensitization group were maintained at or very near the target level for glycated hemoglobin. Moreover, the insulin-sensitization strategy was associated with fewer severe hypoglycemic episodes, less weight gain, and higher HDL levels than those in the insulin-provision strategy. These data may suggest that insulin sensitization is preferable for patients with type 2 diabetes and coronary disease

by internalmedicine | 2009-06-08 09:14 | 動脈硬化/循環器  

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