Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes
Open accessAbstract
BACKGROUND: Cardiovascular morbidity is a major burden in patients with type 2 diabetes. In the Steno-2 Study, we compared the effect of a targeted, intensified, multifactorial intervention with that of conventional treatment on modifiable risk factors for cardiovascular disease in patients with type 2 diabetes and microalbuminuria. METHODS: The primary end point of this open, parallel trial was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, revascularization, and amputation. Eighty patients were randomly assigned to receive conventional treatment in accordance with national guidelines and 80 to receive intensive treatment, with a stepwise implementation of behavior modification and pharmacologic therapy that targeted hyperglycemia, hypertension, dyslipidemia, and microalbuminuria, along with secondary prevention of cardiovascular disease with aspirin. RESULTS: The mean age of the patients was 55.1 years, and the mean follow-up was 7.8 years. The decline in glycosylated hemoglobin values, systolic and diastolic blood pressure, serum cholesterol and triglyceride levels measured after an overnight fast, and urinary albumin excretion rate were all significantly greater in the intensive-therapy group than in the conventional-therapy group. Patients receiving intensive therapy also had a significantly lower risk of cardiovascular disease (hazard ratio, 0.47; 95 percent confidence interval, 0.24 to 0.73), nephropathy (hazard ratio, 0.39; 95 percent confidence interval, 0.17 to 0.87), retinopathy (hazard ratio, 0.42; 95 percent confidence interval, 0.21 to 0.86), and autonomic neuropathy (hazard ratio, 0.37; 95 percent confidence interval, 0.18 to 0.79). CONCLUSIONS: A target-driven, long-term, intensified intervention aimed at multiple risk factors in patients with type 2 diabetes and microalbuminuria reduces the risk of cardiovascular and microvascular events by about 50 percent.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Cardiovascular reflex tests that measure heart rate variability changes during deep breathing, Valsalva maneuver, and supine-to-standing remain the gold standard and are available in clinical care.
“Although HRV testing is largely confined to the research setting, the CV reflex tests that assess changes in HRV during standardized clinical challenges such as deep breathing, Valsalva maneuver and supine-to-standing position remain the gold standard tests and are available for clinical care as well.547,614,626”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [626]
The Procedures, Measurements, and End Points section (page not available) says the study assessed autonomic neuropathy using ECG RR intervals during paced breathing and an orthostatic-hypotension test. It does not mention the Valsalva maneuver, describe these tests as the gold standard, or establish their availability in clinical care. (LLM, conf=0.85)
Experimental — accuracy not yet measuredIn addition to traditional risk factors, hyperglycemia, hyperinsulinemia, and oxidative stress contribute to endothelial damage, leading to poor arterial function and greater susceptibility to atherogenesis.
“In addition to traditional risk factors, hyperglycemia, hyperinsulinemia, and oxidative stress contribute to endothelial damage, leading to poor arterial function and greater susceptibility to atherogenesis ( 45 , 82 , 289 ).”
From Exercise and Type 2 Diabetes (2010) · cites this paper as [82]
The paper’s introductory passage (labeled Abstract in our copy; page unavailable) identifies hyperglycemia as a risk factor for poor outcomes in patients with type 2 diabetes, including cardiovascular complications. It does not say that hyperglycemia, hyperinsulinemia, or oxidative stress cause endothelial damage, impaired arterial function, or increased susceptibility to atherogenesis. (LLM, conf=0.84)
Experimental — accuracy not yet measuredStudies in people with type 2 diabetes and early CKD demonstrated the long-term benefit of multifactorial intervention on the development of microvascular and macrovascular complications and mortality.
“In addition, studies in people with T2D and early CKD demonstrated the long-term bene fi t of multifactorial intervention on the development of microvascular and macrovascular complications and mortality.”
From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [9]
The Abstract and statistical analysis report that long-term multifactorial intervention reduced cardiovascular and microvascular events in patients with type 2 diabetes and microalbuminuria. The mortality part is not supported: the statistical analysis reports seven cardiovascular deaths in each treatment group, and the demonstrated benefit was for a composite cardiovascular outcome rather than mortality separately. (LLM, conf=0.90)
Experimental — accuracy not yet measuredResults from several randomized controlled trials revealed that more intensive treatment of risk factors in people with increased levels of natriuretic peptides reduces the risk for symptomatic heart failure, heart failure hospitalization, and newly diagnosed left ventricular dysfunction.
“Results from several randomized controlled trials revealed that more intensive treatment of risk factors in people with increased levels of natriuretic peptides reduces the risk for symptomatic heart failure, heart failure hospitalization, and newly diagnosed left ventricular dysfunction (222,227,228).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [227]
The Results (statistical analysis; page unavailable) report that intensive multifactorial treatment reduced a composite cardiovascular outcome in one trial of patients with type 2 diabetes and microalbuminuria. The paper does not report selecting patients by elevated natriuretic peptides or reductions in symptomatic heart failure, heart-failure hospitalization, or newly diagnosed left ventricular dysfunction; it also does not itself establish a finding from several trials. (LLM, conf=0.82)
Experimental — accuracy not yet measuredResults from several randomized controlled trials revealed that more intensive treatment of risk factors in people with increased levels of natriuretic peptides reduces the risk for symptomatic heart failure, heart failure hospitalization, and newly diagnosed left ventricular dysfunction.
“Results from several randomized controlled trials revealed that more intensive treatment of risk factors in people with increased levels of natriuretic peptides reduces the risk for symptomatic heart failure, heart failure hospitalization, and newly diagnosed left ventricular dysfunction (211,216,217).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [216]
The Results (statistical analysis; page not available) report fewer cardiovascular events with intensive multifactorial treatment, supporting the broad risk-reduction point. But the trial enrolled patients with type 2 diabetes and microalbuminuria, not people selected for elevated natriuretic peptides; its listed outcomes do not establish reductions in symptomatic heart failure, heart-failure hospitalization, or newly diagnosed left ventricular dysfunction. (LLM, conf=0.84)
Experimental — accuracy not yet measured
For people who already have diabetes, lifestyle modification and pharmacological treatment, as well as blood pressure and cholesterol control, can delay progression to complications and reduce mortality, or even help with remission, especially if started early.
“For people who already have diabetes, lifestyle modification and pharmacological treatment, as well as blood pressure and cholesterol control, can delay progression to complications and reduce mortality, or even help with remission, especially if started early.1,2,58–62”
From Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants (2024) · cites this paper as [58]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThe Steno-2 intensive multifactorial intervention significantly reduced the incidence of microvascular complications after 4 years and produced a significant 53% risk reduction in macrovascular complications after 8 years.
“The benefit of the intensive multifactorial intervention was demonstrated by a significant reduction in the incidence of microvascular complications after 4 years, and a significant 53% risk reduction in macrovascular complications after 8 years.455”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [455]
ACE inhibitors, angiotensin II receptor blockers, and calcium channel antagonists have been reported to be effective for preventing cardiovascular events in patients with DM.
“Angiotensin-converting enzyme inhibitors812), angiotensin Ⅱ receptor blockers813), and calcium channel antagonists814) have been reported to be effective for preventing cardiovascular events in patients with DM.”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [813]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
(2000) · New England Journal of Medicine · doi:10.1056/nejm200001203420301 · Cited by 8,663 · see citing works
Turner, R. C., Fox, C., Matthews, McElroy, H. H., Cull, C. A., Holman, R. R., Neil, P., Hadden, D. R., Wright, D., Manley, E., et al. (1998) · The Lancet · Cited by 8,419 · see citing works
Sacks, F. M., Pfeffer, M. A., Moye, L. A., Rouleau, J. L., Rutherford, J. D., Cole, T. G., Brown, L., Warnica, J. W., Arnold, J. M. O., Wun, C.-C., et al. (1996) · New England Journal of Medicine · doi:10.1056/nejm199610033351401 · Cited by 7,439 · see citing works
Hansson, L., Zanchetti, A., Carruthers, S. G., Dahlöf, B., Elmfeldt, D., Julius, S., Ménard, J., Rahn, K. H., Wedel, H., & Westerling, S. (1998) · The Lancet · doi:10.1016/s0140-6736(98)04311-6 · Cited by 5,728 · see citing works
(1998) · New England Journal of Medicine · doi:10.1056/nejm199811053391902 · Cited by 5,261 · see citing works
Stearne, M. R., Palmer, S. L., Hammersley, M. S., Franklin, S. L., Spivey, R. S., Lévy, J., Tidy, C. R., Bell, N. J., Steemson, J., Barrow, B. A., et al. (1998) · UCL Discovery (University College London) · Cited by 4,803 · see citing works
Stamler, J., Vaccaro, O., Neaton, J. D., Wentworth, D., & The Multiple Risk Factor Intervention Trial Research Group (1993) · Diabetes Care · doi:10.2337/diacare.16.2.434 · Cited by 4,063 · see citing works
Diabetes and cardiovascular disease. The Framingham study
Kannel, W. B. (1979) · JAMA · doi:10.1001/jama.241.19.2035 · Cited by 3,958 · see citing works
Rubins, H. B., Robins, S. J., Collins, D., Fye, C. L., Anderson, J. W., Elam, M. B., Faas, F. H., Linares, E., Schaefer, E. J., Schectman, G., et al. (1999) · New England Journal of Medicine · doi:10.1056/nejm199908053410604 · Cited by 3,439 · see citing works
Staessen, J. A., Fagard, R., Thijs, L., Celis, H., Arabidze, G. G., Birkenhäger, W. H., Bulpitt, C. J., de Leeuw, P. W., Dollery, C. T., Fletcher, A. E., et al. (1997) · The Lancet · doi:10.1016/s0140-6736(97)05381-6 · Cited by 2,989 · see citing works
Turner, R. C., Millns, H., Neil, H. A. W., Stratton, I. M., Manley, S. E., Matthews, D. R., & Holman, R. R. (1998) · BMJ · doi:10.1136/bmj.316.7134.823 · Cited by 2,014 · see citing works
Microalbuminuria Predicts Clinical Proteinuria and Early Mortality in Maturity-Onset Diabetes
Mogensen, C. E. (1984) · New England Journal of Medicine · doi:10.1056/nejm198402093100605 · Cited by 1,918 · see citing works
Pyörälä, K., Pedersen, T. R., Kjekshus, J., Faergeman, O., Olsson, A. G., Thorgeirsson, G., & The Scandinavian Simvastatin Survival Study (4S) Group (1997) · Diabetes Care · doi:10.2337/diacare.20.4.614 · Cited by 1,623 · see citing works
Gæde, P., Vedel, P., Parving, H.-H., & Pedersen, O. (1999) · The Lancet · doi:10.1016/s0140-6736(98)07368-1 · Cited by 981 · see citing works
Self-citationDiabetes and Decline in Heart Disease Mortality in US Adults
Gu, K. (1999) · JAMA · doi:10.1001/jama.281.14.1291 · Cited by 856 · see citing works
Manson, J. E. (1991) · Archives of Internal Medicine · doi:10.1001/archinte.1991.00400060077013 · Cited by 675 · see citing works
Ravid, M. (1996) · Archives of Internal Medicine · doi:10.1001/archinte.156.3.286 · Cited by 516 · see citing works
Aldington, S. J., KOHNER, E. M., Meuer, S. M., Klein, R., Sj�lie, A. K., & The EURODIAB IDDM Complications Study Group (1995) · Diabetologia · doi:10.1007/bf00410281 · Cited by 381 · see citing works
Albuminuria and Poor Glycemic Control Predict Mortality in NIDDM
Gall, M. ‐., Borch‐Johnsen, K., Hougaard, P., Nielsen, F. S., & Parving, H. ‐. (1995) · Diabetes · doi:10.2337/diabetes.44.11.1303 · Cited by 358 · see citing works
Self-citationGall, M. ‐., Rossing, P. R., Sk�tt, P., Damsbo, P., Vaag, A. A., Bech, K., Dejgaard, A., Lauritzen, M., Lauritzen, E., Hougaard, P., et al. (1991) · Diabetologia · doi:10.1007/bf00400995 · Cited by 351 · see citing works
Self-citationCurb, J. D. (1996) · JAMA · doi:10.1001/jama.276.23.1886 · Cited by 161 · see citing works
Curb, J. D., Pressel, S., Cutler, J. A., Savage, P. J., Applegate, W. B., Black, H. R., Camel, G. H., DAVID, B. R., FROST, P. H., Gonzalez, N. M., et al. (1997) · Survey of Anesthesiology · doi:10.1097/00132586-199712000-00060 · Cited by 62 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
European Guidelines on cardiovascular disease prevention in clinical practice (version 2012)
Authors/Task Force Members:, Perk, J., De Backer, G., Gohlke, H., Graham, I., Reiner, Ž., Verschuren, M., Albus, C., Benlian, P., Boysen, G., et al. (2012) · European Heart Journal · doi:10.1093/eurheartj/ehs092 · Cited by 8,490 · see citing works
Arnett, D. K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z. D., Hahn, E. J., Himmelfarb, C. D., Khera, A., Lloyd-Jones, D., McEvoy, J. W., et al. (2019) · Circulation · doi:10.1161/cir.0000000000000678 · Cited by 4,536 · see citing works
Standards of medical care in diabetes—2014
American Diabetes Association (2014) · Diabetes Care · doi:10.2337/dc14-s014 · Cited by 4,572 · see citing works
Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes
Wanner, C., Inzucchi, S. E., Lachin, J. M., Fitchett, D., von Eynatten, M., Mattheus, M., Johansen, O. E., Woerle, H. J., Broedl, U. C., & Zinman, B. (2016) · New England Journal of Medicine · doi:10.1056/nejmoa1515920 · Cited by 3,655 · see citing works
Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases
Pedersen, B. K., & Saltin, B. (2015) · Scandinavian Journal of Medicine & Science in Sports · doi:10.1111/sms.12581 · Cited by 3,514 · see citing works
Effect of a multifactorial intervention on mortality in type 2 diabetes
Gæde, P., Lund-Andersen, H., Parving, H.-H., & Pedersen, O. (2008) · New England Journal of Medicine · doi:10.1056/nejmoa0706245 · Cited by 3,489 · see citing works
Self-citationPathophysiology of type 2 diabetes mellitus
Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B., Ostolaza, H., & Martín, C. (2020) · International Journal of Molecular Sciences · doi:10.3390/ijms21176275 · Cited by 3,360 · see citing works
Diabetic neuropathy: A position statement by the American Diabetes Association
Pop-Busui, R., Boulton, A. J. M., Feldman, E. L., Bril, V., Freeman, R., Malik, R. A., Sosenko, J. M., & Ziegler, D. (2017) · Diabetes Care · doi:10.2337/dc16-2042 · Cited by 2,602 · see citing works
Monnier, L., Mas, E., Ginet, C., Michel, F., Villon, L., Cristol, J.-P., & Colette, C. (2006) · JAMA · doi:10.1001/jama.295.14.1681 · Cited by 2,444 · see citing works
Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and prevention
Gansevoort, R. T., Correa-Rotter, R., Hemmelgarn, B. R., Jafar, T. H., Heerspink, H. J. L., Mann, J. F., Matsushita, K., & Wen, C. P. (2013) · The Lancet · doi:10.1016/s0140-6736(13)60595-4 · Cited by 2,213 · see citing works
Colberg, S. R., Sigal, R. J., Fernhall, B., Regensteiner, J. G., Blissmer, B. J., Rubin, R. R., Chasan-Taber, L., Albright, A. L., & Braun, B. (2010) · Diabetes Care · doi:10.2337/dc10-9990 · Cited by 1,955 · see citing works
“In addition to traditional risk factors, hyperglycemia, hyperinsulinemia, and oxidative stress contribute to endothelial damage, leading to poor arterial function and greater susceptibility to atherogenesis (45,82,289).”
2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease
Arnett, D. K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z. D., Hahn, E. J., Himmelfarb, C. D., Khera, A., Lloyd-Jones, D., McEvoy, J. W., et al. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2019.03.010 · Cited by 1,896 · see citing works
Sacco, R. L., Adams, R., Albers, G., Alberts, M. J., Benavente, O., Furie, K., Goldstein, L. B., Gorelick, P., Halperin, J., Harbaugh, R., et al. (2006) · Stroke · doi:10.1161/01.str.0000199147.30016.74 · Cited by 1,873 · see citing works
Diabetic nephropathy: diagnosis, prevention, and treatment
Gross, J. L., de Azevedo, M. J., Silveiro, S. P., Canani, L. H., Caramori, M. L., & Zelmanovitz, T. (2005) · Diabetes Care · doi:10.2337/diacare.28.1.164 · Cited by 1,839 · see citing works
Changes in diabetes-related complications in the United States, 1990-2010
Gregg, E. W., Li, Y., Wang, J., Rios Burrows, N., Ali, M. K., Rolka, D., Williams, D. E., & Geiss, L. (2014) · New England Journal of Medicine · doi:10.1056/nejmoa1310799 · Cited by 1,749 · see citing works
Collaborative care for patients with depression and chronic illnesses
Katon, W. J., Lin, E. H. B., Von Korff, M., Ciechanowski, P., Ludman, E. J., Young, B., Peterson, D., Rutter, C. M., McGregor, M., & McCulloch, D. (2010) · New England Journal of Medicine · doi:10.1056/nejmoa1003955 · Cited by 1,697 · see citing works
Mancia, G., Laurent, S., Agabiti-Rosei, E., Ambrosioni, E., Burnier, M., Caulfield, M. J., Cifkova, R., Clément, D., Coca, A., Dominiczak, A., et al. (2009) · Journal of Hypertension · doi:10.1097/hjh.0b013e328333146d · Cited by 1,643 · see citing works
Risk factors, mortality, and cardiovascular outcomes in patients with type 2 diabetes
Rawshani, A., Rawshani, A., Franzén, S., Sattar, N., Eliasson, B., Svensson, A.-M., Zethelius, B., Miftaraj, M., McGuire, D. K., Rosengren, A., et al. (2018) · New England Journal of Medicine · doi:10.1056/nejmoa1800256 · Cited by 1,475 · see citing works
KDIGO 2020 Clinical practice guideline for diabetes management in chronic kidney disease
de Boer, I. H., Caramori, M. L., Chan, J. C. N., Heerspink, H. J. L., Hurst, C., Khunti, K., Liew, A., Michos, E. D., Navaneethan, S. D., Olowu, W. A., et al. (2020) · Kidney International · doi:10.1016/j.kint.2020.06.019 · Cited by 1,399 · see citing works
Evidence for prescribing exercise as therapy in chronic disease
Pedersen, B. K., & Saltin, B. (2006) · Scandinavian Journal of Medicine & Science in Sports · doi:10.1111/j.1600-0838.2006.00520.x · Cited by 1,384 · see citing works
Mortality and cardiovascular disease in type 1 and type 2 diabetes
Rawshani, A., Rawshani, A., Franzén, S., Eliasson, B., Svensson, A.-M., Miftaraj, M., McGuire, D. K., Sattar, N., Rosengren, A., & Gudbjörnsdottir, S. (2017) · New England Journal of Medicine · doi:10.1056/nejmoa1608664 · Cited by 1,389 · see citing works
KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease
Rossing, P., Caramori, M. L., Chan, J. C. N., Heerspink, H. J. L., Hurst, C., Khunti, K., Liew, A., Michos, E. D., Navaneethan, S. D., Olowu, W. A., et al. (2022) · Kidney International · doi:10.1016/j.kint.2022.06.008 · Cited by 1,373 · see citing works
Cardiorenal end points in a trial of aliskiren for type 2 diabetes
Parving, H.-H., Brenner, B. M., McMurray, J. J. V., de Zeeuw, D., Haffner, S. M., Solomon, S. D., Chaturvedi, N., Persson, F., Desai, A. S., Nicolaides, M., et al. (2012) · New England Journal of Medicine · doi:10.1056/nejmoa1208799 · Cited by 1,319 · see citing works
Self-citationLeon, B. M. (2015) · World Journal of Diabetes · doi:10.4239/wjd.v6.i13.1246 · Cited by 1,215 · see citing works
Diabetic kidney disease: a report from an ADA Consensus Conference
Tuttle, K. R., Bakris, G. L., Bilous, R. W., Chiang, J. L., de Boer, I. H., Goldstein-Fuchs, J., Hirsch, I. B., Kalantar-Zadeh, K., Narva, A. S., Navaneethan, S. D., et al. (2014) · Diabetes Care · doi:10.2337/dc14-1296 · Cited by 1,153 · see citing works
Relationship of Depression and Diabetes Self-Care, Medication Adherence, and Preventive Care
Lin, E. H. B., Katon, W., Von Korff, M., Rutter, C., Simon, G. E., Oliver, M., Ciechanowski, P., Ludman, E. J., Bush, T., & Young, B. (2004) · Diabetes Care · doi:10.2337/diacare.27.9.2154 · Cited by 1,146 · see citing works
Global guideline for type 2 diabetes
(2014) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2012.10.001 · Cited by 1,064 · see citing works
Zhou, B., Rayner, A. W., Gregg, E. W., Sheffer, K. E., Carrillo-Larco, R. M., Bennett, J. E., Shaw, J. E., Paciorek, C. J., Singleton, R. K., Barradas Pires, A., et al. (2024) · The Lancet · doi:10.1016/s0140-6736(24)02317-1 · Cited by 1,013 · see citing works
Khaw, K.-T., Wareham, N., Bingham, S., Luben, R., Welch, A., & Day, N. (2004) · Annals of Internal Medicine · doi:10.7326/0003-4819-141-6-200409210-00006 · Cited by 974 · see citing works
New Horizons in Diabetic Neuropathy: Mechanisms, Bioenergetics, and Pain
Feldman, E. L., Nave, K.-A., Jensen, T. S., & Bennett, D. L. H. (2017) · Neuron · doi:10.1016/j.neuron.2017.02.005 · Cited by 915 · see citing works
Boulton, A. J. M., Malik, R. A., Arezzo, J. C., & Sosenko, J. M. (2004) · Diabetes Care · doi:10.2337/diacare.27.6.1458 · Cited by 913 · see citing works
Fihn, S. D., Gardin, J. M., Abrams, J., Berra, K., Blankenship, J. C., Dallas, A. P., Douglas, P. S., Foody, J. M., Gerber, T. C., Hinderliter, A. L., et al. (2012) · Circulation · doi:10.1161/cir.0b013e318277d6a0 · Cited by 845 · see citing works
Lackland, D. T., Roccella, E. J., Deutsch, A. F., Fornage, M., George, M. G., Howard, G., Kissela, B. M., Kittner, S. J., Lichtman, J. H., Lisabeth, L. D., et al. (2014) · Stroke · doi:10.1161/01.str.0000437068.30550.cf · Cited by 815 · see citing works
Young, L. H., Wackers, F. J. T., Chyun, D. A., Davey, J. A., Barrett, E. J., Taillefer, R., Heller, G. V., Iskandrian, A. E., Wittlin, S. D., Filipchuk, N., et al. (2009) · JAMA · doi:10.1001/jama.2009.476 · Cited by 809 · see citing works
Kotseva, K., Wood, D., Backer, G. D., Bacquer, D. D., Pyörälä, K., Keil, U., & EUROASPIRE Study Group (2009) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1097/hjr.0b013e3283294b1d · Cited by 812 · see citing works
Kinoshita, M., Yokote, K., Arai, H., Iida, M., Ishigaki, Y., Ishibashi, S., Umemoto, S., Egusa, G., Ohmura, H., Okamura, T., et al. (2018) · Journal of Atherosclerosis and Thrombosis · doi:10.5551/jat.gl2017 · Cited by 813 · see citing works
Bakris, G. L., Fonseca, V., Katholi, R. E., McGill, J. B., Messerli, F. H., Phillips, R. A., Raskin, P., Wright, J. T., Oakes, R., Lukas, M. A., et al. (2004) · JAMA · doi:10.1001/jama.292.18.2227 · Cited by 792 · see citing works
Renal and retinal effects of enalapril and losartan in type 1 diabetes
Mauer, M., Zinman, B., Gardiner, R., Suissa, S., Sinaiko, A., Strand, T., Drummond, K., Donnelly, S., Goodyer, P., Gubler, M. C., et al. (2009) · New England Journal of Medicine · doi:10.1056/nejmoa0808400 · Cited by 791 · see citing works
Long-term follow-up after tight control of blood pressure in type 2 diabetes
Holman, R. R., Paul, S. K., Bethel, M. A., Neil, H. A. W., & Matthews, D. R. (2008) · New England Journal of Medicine · doi:10.1056/nejmoa0806359 · Cited by 762 · see citing works
Bassuk, S. S., & Manson, J. E. (2005) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00160.2005 · Cited by 744 · see citing works
Diabetes and mortality following acute coronary syndromes
Donahoe, S. M., Stewart, G. C., McCabe, C. H., Mohanavelu, S., Murphy, S. A., Cannon, C. P., & Antman, E. M. (2007) · JAMA · doi:10.1001/jama.298.7.765 · Cited by 716 · see citing works
Trends in diabetes treatment and control in U.S. adults, 1999-2018
Fang, M., Wang, D., Coresh, J., & Selvin, E. (2021) · New England Journal of Medicine · doi:10.1056/nejmsa2032271 · Cited by 690 · see citing works
Hermansen, K., Davies, M., Derezinski, T., Martinez Ravn, G., Clauson, P., Home, P., & on behalf of the Levemir Treat-to-Target Study Group (2006) · Diabetes Care · doi:10.2337/dc05-1365 · Cited by 627 · see citing works
Trends in cardiovascular complications of diabetes
Fox, C. S. (2004) · JAMA · doi:10.1001/jama.292.20.2495 · Cited by 626 · see citing works
JBS3 Board (2014) · Heart · doi:10.1136/heartjnl-2014-305693 · Cited by 608 · see citing works
(2010) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e3181eeb61c · Cited by 567 · see citing works
Japanese clinical practice guideline for diabetes 2019
Araki, E., Goto, A., Kondo, T., Noda, M., Noto, H., Origasa, H., Osawa, H., Taguchi, A., Tanizawa, Y., Tobe, K., et al. (2020) · Diabetology International · doi:10.1007/s13340-020-00439-5 · Cited by 545 · see citing works
Gæde, P., Oellgaard, J., Carstensen, B., Rossing, P., Lund-Andersen, H., Parving, H.-H., & Pedersen, O. (2016) · Diabetologia · doi:10.1007/s00125-016-4065-6 · Cited by 528 · see citing works
Self-citationPredictors of Adherence With Antihypertensive and Lipid-Lowering Therapy
Chapman, R. H. (2005) · Archives of Internal Medicine · doi:10.1001/archinte.165.10.1147 · Cited by 506 · see citing works
Blonde, L., Umpierrez, G. E., Reddy, S. S., McGill, J. B., Berga, S. L., Bush, M., Chandrasekaran, S., DeFronzo, R. A., Einhorn, D., Galindo, R. J., et al. (2022) · Endocrine Practice · doi:10.1016/j.eprac.2022.08.002 · Cited by 507 · see citing works
Das, S. R., Everett, B. M., Birtcher, K. K., Brown, J. M., Januzzi, J. L., Kalyani, R. R., Kosiborod, M., Magwire, M., Morris, P. B., Neumiller, J. J., et al. (2020) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2020.05.037 · Cited by 466 · see citing works
Multiple behavioral risk factor interventions in primary care
Goldstein, M. G., Whitlock, E. P., & DePue, J. (2004) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2004.04.023 · Cited by 467 · see citing works
Fruchart, J.-C., Sacks, F., Hermans, M. P., Assmann, G., Brown, W. V., Ceska, R., Chapman, M. J., Dodson, P. M., Fioretto, P., Ginsberg, H. N., et al. (2008) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2008.10.002 · Cited by 463 · see citing works
Griffin, S. J., Borch-Johnsen, K., Davies, M. J., Khunti, K., Rutten, G. E., Sandbæk, A., Sharp, S. J., Simmons, R. K., van den Donk, M., Wareham, N. J., et al. (2011) · The Lancet · doi:10.1016/s0140-6736(11)60698-3 · Cited by 462 · see citing works
Degn, K. B., Juhl, C. B., Sturis, J., Jakobsen, G., Brock, B., Chandramouli, V., Rungby, J., Landau, B. R., & Schmitz, O. (2004) · Diabetes · doi:10.2337/diabetes.53.5.1187 · Cited by 427 · see citing works
Diverse causes of hypoglycemia-associated autonomic failure in diabetes.
Cryer, P. E. (2004) · New England Journal of Medicine · doi:10.1056/nejmra031354 · Cited by 411 · see citing works
GLP-1 and the kidney: from physiology to pharmacology and outcomes in diabetes
Muskiet, M. H. A., Tonneijck, L., Smits, M. M., van Baar, M. J. B., Kramer, M. H. H., Hoorn, E. J., Joles, J. A., & van Raalte, D. H. (2017) · Nature Reviews Nephrology · doi:10.1038/nrneph.2017.123 · Cited by 407 · see citing works
Diabetes structured self-management education programmes: a narrative review and current innovations
Chatterjee, S., Davies, M. J., Heller, S., Speight, J., Snoek, F. J., & Khunti, K. (2018) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(17)30239-5 · Cited by 372 · see citing works
Glucagon-Like Peptide 1 Receptor Agonists for Type 2 Diabetes
Hinnen, D. (2017) · Diabetes Spectrum · doi:10.2337/ds16-0026 · Cited by 394 · see citing works
Hemmingsen, B., Lund, S. S., Gluud, C., Vaag, A., Almdal, T., Hemmingsen, C., & Wetterslev, J. (2011) · BMJ · doi:10.1136/bmj.d6898 · Cited by 386 · see citing works
A systematic review of interventions to improve diabetes care in socially disadvantaged populations
Glazier, R. H., Bajcar, J., Kennie, N. R., & Willson, K. (2006) · Diabetes Care · doi:10.2337/dc05-1942 · Cited by 385 · see citing works
Huelsmann, M., Neuhold, S., Resl, M., Strunk, G., Brath, H., Francesconi, C., Adlbrecht, C., Prager, R., Luger, A., Pacher, R., et al. (2013) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2013.05.069 · Cited by 385 · see citing works
Kloppenborg, R. P., van den Berg, E., Kappelle, L. J., & Biessels, G. J. (2008) · European Journal of Pharmacology · doi:10.1016/j.ejphar.2008.02.049 · Cited by 368 · see citing works
Hong, J., Zhang, Y., Lai, S., Lv, A., Su, Q., Dong, Y., Zhou, Z., Tang, W., Zhao, J., Cui, L., et al. (2013) · Diabetes Care · doi:10.2337/dc12-0719 · Cited by 366 · see citing works
Systematic review: glucose control and cardiovascular disease in type 2 diabetes
Kelly, T. N., Bazzano, L. A., Fonseca, V. A., Thethi, T. K., Reynolds, K., & He, J. (2009) · Annals of Internal Medicine · doi:10.7326/0003-4819-151-6-200909150-00137 · Cited by 358 · see citing works
Computer-based diabetes self-management interventions for adults with type 2 diabetes mellitus
Pal, K., Eastwood, S. V., Michie, S., Farmer, A. J., Barnard, M. L., Peacock, R., Wood, B., Inniss, J. D., & Murray, E. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008776.pub2 · Cited by 344 · see citing works
10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025
American Diabetes Association Professional Practice Committee, ElSayed, N. A., McCoy, R. G., Aleppo, G., Balapattabi, K., Beverly, E. A., Briggs Early, K., Bruemmer, D., Das, S. R., Echouffo-Tcheugui, J. B., et al. (2025) · Diabetes Care · doi:10.2337/dc25-s010 · Cited by 339 · see citing works
Ginsberg, H. N., & MacCallum, P. R. (2009) · Journal of the CardioMetabolic Syndrome · doi:10.1111/j.1559-4572.2008.00044.x · Cited by 331 · see citing works
(2014) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(14)70156-1 · Cited by 319 · see citing works
Hardeman, W., Sutton, S., Griffin, S., Johnston, M., White, A., Wareham, N. J., & Kinmonth, A. L. (2005) · Health Education Research · doi:10.1093/her/cyh022 · Cited by 311 · see citing works
Fisher, D. P., Johnson, E., Haneuse, S., Arterburn, D., Coleman, K. J., O’Connor, P. J., O’Brien, R., Bogart, A., Theis, M. K., Anau, J., et al. (2018) · JAMA · doi:10.1001/jama.2018.14619 · Cited by 305 · see citing works
Ueki, K., Sasako, T., Okazaki, Y., Kato, M., Okahata, S., Katsuyama, H., Haraguchi, M., Morita, A., Ohashi, K., Hara, K., et al. (2017) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(17)30327-3 · Cited by 313 · see citing works
Das, S. R., Everett, B. M., Birtcher, K. K., Brown, J. M., Cefalu, W. T., Januzzi, J. L., Kalyani, R. R., Kosiborod, M., Magwire, M. L., Morris, P. B., et al. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.09.020 · Cited by 300 · see citing works
Quality of Diabetes Care in U.S. Academic Medical Centers
Grant, R. W., Buse, J. B., Meigs, J. B., & for the University HealthSystem Consortium (UHC) Diabetes Benchmarking Project Team (2005) · Diabetes Care · doi:10.2337/diacare.28.2.337 · Cited by 311 · see citing works
Aroda, V. R., Ahmann, A., Cariou, B., Chow, F., Davies, M. J., Jódar, E., Mehta, R., Woo, V., & Lingvay, I. (2019) · Diabetes & Metabolism · doi:10.1016/j.diabet.2018.12.001 · Cited by 296 · see citing works
de Boer, I. H., Caramori, M. L., Chan, J. C. N., Heerspink, H. J. L., Hurst, C., Khunti, K., Liew, A., Michos, E. D., Navaneethan, S. D., Olowu, W. A., et al. (2020) · Kidney International · doi:10.1016/j.kint.2020.06.024 · Cited by 278 · see citing works
Schernthaner, G., Grimaldi, A., Di Mario, U., Drzewoski, J., Kempler, P., Kvapil, M., Novials, A., Rottiers, R., Rutten, G. E. H. M., & Shaw, K. M. (2004) · European Journal of Clinical Investigation · doi:10.1111/j.1365-2362.2004.01381.x · Cited by 271 · see citing works
Fruchart, J.-C., Sacks, F. M., Hermans, M. P., Assmann, G., Brown, W. V., Ceska, R., Chapman, M. J., Dodson, P. M., Fioretto, P., Ginsberg, H. N., et al. (2008) · Diabetes and Vascular Disease Research · doi:10.3132/dvdr.2008.046 · Cited by 260 · see citing works
Elkeles, R. S., Godsland, I. F., Feher, M. D., Rubens, M. B., Roughton, M., Nugara, F., Humphries, S. E., Richmond, W., Flather, M. D., & for the PREDICT Study Group (2008) · European Heart Journal · doi:10.1093/eurheartj/ehn279 · Cited by 261 · see citing works
Margolis, K. L., O’Connor, P. J., Morgan, T. M., Buse, J. B., Cohen, R. M., Cushman, W. C., Cutler, J. A., Evans, G. W., Gerstein, H. C., Grimm, R. H., et al. (2014) · Diabetes Care · doi:10.2337/dc13-2334 · Cited by 259 · see citing works
Udell, J. A., Cavender, M. A., Bhatt, D. L., Chatterjee, S., Farkouh, M. E., & Scirica, B. M. (2015) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(15)00044-3 · Cited by 254 · see citing works
Screening for coronary artery disease in patients with diabetes
Bax, J. J., Young, L. H., Frye, R. L., Bonow, R. O., Steinberg, H. O., & Barrett, E. J. (2007) · Diabetes Care · doi:10.2337/dc07-9927 · Cited by 251 · see citing works
Thyroid hormone mimetics: potential applications in atherosclerosis, obesity and type 2 diabetes
Baxter, J. D., & Webb, P. (2009) · Nature Reviews Drug Discovery · doi:10.1038/nrd2830 · Cited by 253 · see citing works
Toobert, D. J., Glasgow, R. E., Strycker, L. A., Barrera, M., Ritzwoller, D. P., & Weidner, G. (2007) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/1479-5868-4-1 · Cited by 255 · see citing works
Detection of Coronary Artery Disease in Asymptomatic Patients With Type 2 Diabetes Mellitus
Scognamiglio, R., Negut, C., Ramondo, A., Tiengo, A., & Avogaro, A. (2006) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2005.10.008 · Cited by 249 · see citing works
Fruchart, J.-C. (2009) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2009.03.008 · Cited by 233 · see citing works
Goff, D. C., Gerstein, H. C., Ginsberg, H. N., Cushman, W. C., Margolis, K. L., Byington, R. P., Buse, J. B., Genuth, S., Probstfield, J. L., & Simons-Morton, D. G. (2007) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2007.03.002 · Cited by 229 · see citing works
de Pablos‐Velasco, P., Parhofer, K. G., Bradley, C., Eschwège, E., Gönder-Frederick, L., Maheux, P., Wood, I., & Simon, D. (2014) · Clinical Endocrinology · doi:10.1111/cen.12119 · Cited by 218 · see citing works
Liu, G., Li, Y., Hu, Y., Zong, G., Li, S., Rimm, E. B., Hu, F. B., Manson, J. E., Rexrode, K. M., Shin, H. J., et al. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.04.027 · Cited by 221 · see citing works
Impact of obesity on cardiovascular disease
Zalesin, K. C., Franklin, B. A., Miller, W. M., Peterson, E. D., & McCullough, P. A. (2011) · Medical Clinics of North America · doi:10.1016/j.mcna.2011.06.005 · Cited by 231 · see citing works
Exercise, Vascular Wall and Cardiovascular Diseases: An Update (Part 1)
Leung, F. P., Yung, L. M., Laher, I., Yao, X., Chen, Z. Y., & Huang, Y. (2008) · Sports Medicine · doi:10.2165/00007256-200838120-00005 · Cited by 219 · see citing works
Antecedent Hypoglycemia Impairs Autonomic Cardiovascular Function
Adler, G. K., Bonyhay, I., Failing, H., Waring, E., Dotson, S., & Freeman, R. (2009) · Diabetes · doi:10.2337/db08-1153 · Cited by 216 · see citing works
Primary Prevention of Cardiovascular Disease in Diabetes Mellitus
Newman, J. D., Schwartzbard, A. Z., Weintraub, H. S., Goldberg, I. J., & Berger, J. S. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.07.001 · Cited by 205 · see citing works
Geng, T., Zhu, K., Lu, Q., Wan, Z., Chen, X., Liu, L., Pan, A., & Liu, G. (2023) · PLOS Medicine · doi:10.1371/journal.pmed.1004135 · Cited by 205 · see citing works
Fruchart, J.-C. (2013) · Cardiovascular Diabetology · doi:10.1186/1475-2840-12-82 · Cited by 189 · see citing works
Autonomic Neuropathy in Diabetes Mellitus
Verrotti, A., Prezioso, G., Scattoni, R., & Chiarelli, F. (2014) · Frontiers in Endocrinology · doi:10.3389/fendo.2014.00205 · Cited by 187 · see citing works
Vijan, S., Sussman, J. B., Yudkin, J. S., & Hayward, R. A. (2014) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2014.2894 · Cited by 185 · see citing works
Insulin therapy for type 2 diabetes.
Swinnen, S. G., Hoekstra, J. B., & DeVries, J. H. (2009) · Diabetes Care · doi:10.2337/dc09-s318 · Cited by 181 · see citing works
Liu, J., Grundy, S. M., Wang, W., Smith, S. C., Lena Vega, G., Wu, Z., Zeng, Z., Wang, W., & Zhao, D. (2007) · American Heart Journal · doi:10.1016/j.ahj.2007.01.003 · Cited by 177 · see citing works
Diabetes mellitus and stroke: A clinical update
Tun, N. N., Arunagirinathan, G., Munshi, S. K., & Pappachan, J. M. (2017) · World Journal of Diabetes · doi:10.4239/wjd.v8.i6.235 · Cited by 177 · see citing works
- Authors
- Gæde, P., Vedel, P., Larsen, N., Jensen, G. V. H., Parving, H.-H., & Pedersen, O.
- Affiliations
- Steno Diabetes Center Copenhagen (DK)
- Herlev Hospital (DK)
- Roskilde Sygehus (DK)
- Aarhus University (DK)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2003-01-30
- Volume
- 348
- Issue
- 5
- Pages
- 383-393
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2139634859
- Cited by
- 4,378
- References
- 26
- Citations by year
- 2026: 47 · 2025: 71 · 2024: 108 · 2023: 110 · 2022: 102 · 2021: 137 · 2020: 142 · 2019: 133 · 2018: 171 · 2017: 143 · 2016: 158 · 2015: 169 · 2014: 198 · 2013: 184 · 2012: 235
- FWCI
- 178.78
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 2 diabetes, cardiovascular disease, multifactorial intervention, microalbuminuria, tight glycemic control, hyperglycemia, hypertension, dyslipidemia, aspirin, myocardial infarction, stroke, kidney disease, retinopathy, autonomic neuropathy
- MeSH terms
- Amputation, Surgical, Angiotensin II, Angiotensin-Converting Enzyme Inhibitors, Antihypertensive Agents, Hypolipidemic Agents, Cardiovascular Diseases, Combined Modality Therapy, Diabetes Mellitus, Diabetes Mellitus, Type 2, Female, Humans, Hyperlipidemias, Hypertension, Hypoglycemic Agents, Male, Middle Aged, Myocardial Infarction, Obesity, Risk Factors, Vitamins, Exercise, Smoking Cessation, Diet, Fat-Restricted, Stroke
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
