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Cited by 981Chronic Kidney Disease and DiabetesDiabetes Treatment and ManagementDiabetes Management and Research

Intensified multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: the Steno type 2 randomised study

Gæde, Peter, Vedel, Pernille, Parving, Hans-Henrik, Pedersen, Oluf·1999·The Lancet
DOI 10.1016/s0140-6736(98)07368-1
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Abstract

Background In type 2 diabetes mellitus the aetiology of long-term complications is multifactorial. We carried out a randomised trial of stepwise intensive treatment or standard treatment of risk factors in patients with microalbuminuria. Methods In this open, parallel trial patients were allocated standard treatment (n=80) or intensive treatment (n=80). Standard treatment followed Danish guidelines. Intensive treatment was a stepwise implementation of behaviour modification, pharmacological therapy targeting hyperglycaemia, hypertension, dyslipidaemia, and microalbuminuria. The primary endpoint was the development of nephropathy (median albumin excretion rate >300 mg per 24 h in at least one of the two-yearly examinations). Secondary endpoints were the incidence or progression of diabetic retinopathy and neuropathy. Findings The mean age was 55.1 years (SD 7.2) and patients were followed up for 3.8 years (0.3). Patients in the intensive group had significantly lower rates of progression to nephropathy (odds ratio 0.27 [95% CI 0-10-0.75]), progression of retinopathy (0.45 [0.21-0.95]), and progression of autonomic neuropathy (0.32 [0.12-0.78]) than those in the standard group. Interpretation Intensified multifactorial intervention in patients with type 2 diabetes and microalbuminuria slows progression to nephropathy, and progression of retinopathy and autonomic neuropathy. However, further studies are needed to establish the effect of intensified multifactorial treatment on ma…

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Crossref · 10.1016/s0140-6736(98)07368-1

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  • An HbA1c target of ≤6.5% probably decreased the incidence of moderately increased albuminuria and kidney failure.

    “Six studies compared a target HbA1c of # 6.5% to higher HbA1c targets (standard glycemic control) and found that an HbA1c target of # 6.5% probably decreased the incidence of moderately increased albuminuria, and kidney failure (Supplementary Table S12 239,240,242 -244,252 )”

    From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [243]

  • The Steno-2 Study encompassed treatment goals similar to those recommended in the current guidelines of the American Diabetes Association.

    “The study encompassed treatment goals similar to those recommended in the current guidelines of the American Diabetes Association.11”

    From Effect of a multifactorial intervention on mortality in type 2 diabetes (2008) · cites this paper as [11]

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Authors
Gæde, P., Vedel, P., Parving, H.-H., & Pedersen, O.
Affiliations
Steno Diabetes Center Copenhagen (DK)
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
1999-02
Volume
353
Issue
9153
Pages
617-622
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(98)07368-1
OpenAlex
W2026480246
Cited by
981
References
3
Citations by year
2026: 12 · 2025: 11 · 2024: 17 · 2023: 21 · 2022: 30 · 2021: 16 · 2020: 32 · 2019: 26 · 2018: 39 · 2017: 29 · 2016: 38 · 2015: 34 · 2014: 57 · 2013: 46 · 2012: 48
FWCI
36.31
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
type 2 diabetes, microalbuminuria, diabetic nephropathy, diabetic retinopathy, diabetic neuropathy, autonomic neuropathy, urinary albumin excretion rate, hyperglycemia, hypertension, dyslipidemia, behavior modification
MeSH terms
Albuminuria, Analysis of Variance, Autonomic Nervous System Diseases, Behavior Therapy, Diabetes Mellitus, Type 2, Diabetic Nephropathies, Diabetic Neuropathies, Diabetic Retinopathy, Female, Follow-Up Studies, Humans, Hyperglycemia, Hyperlipidemias, Hypertension, Hypoglycemic Agents, Male, Middle Aged, Risk Factors, Logistic Models, Odds Ratio, Disease Progression

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