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Cited by 3,489Chronic Kidney Disease and DiabetesDiabetes Treatment and ManagementBlood Pressure and Hypertension Studies

Effect of a multifactorial intervention on mortality in type 2 diabetes

Open access
Gæde, Peter, Lund-Andersen, Henrik, Parving, Hans-Henrik, Pedersen, Oluf·2008·New England Journal of Medicine
DOI 10.1056/nejmoa0706245
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Abstract

BACKGROUND: Intensified multifactorial intervention - with tight glucose regulation and the use of renin-angiotensin system blockers, aspirin, and lipid-lowering agents - has been shown to reduce the risk of nonfatal cardiovascular disease among patients with type 2 diabetes mellitus and microalbuminuria. We evaluated whether this approach would have an effect on the rates of death from any cause and from cardiovascular causes. METHODS: In the Steno-2 Study, we randomly assigned 160 patients with type 2 diabetes and persistent microalbuminuria to receive either intensive therapy or conventional therapy; the mean treatment period was 7.8 years. Patients were subsequently followed observationally for a mean of 5.5 years, until December 31, 2006. The primary end point at 13.3 years of follow-up was the time to death from any cause. RESULTS: Twenty-four patients in the intensive-therapy group died, as compared with 40 in the conventional-therapy group (hazard ratio, 0.54; 95% confidence interval [CI], 0.32 to 0.89; P=0.02). Intensive therapy was associated with a lower risk of death from cardiovascular causes (hazard ratio, 0.43; 95% CI, 0.19 to 0.94; P=0.04) and of cardiovascular events (hazard ratio, 0.41; 95% CI, 0.25 to 0.67; P<0.001). One patient in the intensive-therapy group had progression to end-stage renal disease, as compared with six patients in the conventional-therapy group (P=0.04). Fewer patients in the intensive-therapy group required retinal photocoagulation (relative risk, 0.45; 95% CI, 0.23 to 0.86; P=0.02). Few major side effects were reported. CONCLUSIONS: In at-risk patients with type 2 diabetes, intensive intervention with multiple drug combinations and behavior modification had sustained beneficial effects with respect to vascular complications and on rates of death from any cause and from cardiovascular causes. (ClinicalTrials.gov number, NCT00320008.)

Integrity signals

Registry

Crossref · 10.1056/nejmoa0706245

Cites

41 of 41 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

5 of 30 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Trials of interventions for single risk factors have shown efficacy in reducing the development and progression of complications.

    “However, trials of interventions for single risk factors have shown efficacy in reducing the development and progression of complications.[4][5][6][7][8][9]”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [4] source
    • cites [5] source
    • cites [6] source
  • Premisecitation

    The risk of vascular complications was reduced by about half in the Steno-2 Study during an average of 7.8 years of intensified multitarget intervention aimed at concomitant risk factors.

    “Furthermore, the risk of vascular complications was reduced by about half in the Steno-2 Study, our previous prospective, randomized, open-label, blinded trial, during an average of 7.8 years of intensified multitarget intervention aimed at concomitant risk factors.10”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [10] source

      The Glycemic goals section discusses intensive treatment and vascular complications in other studies, but it does not report the Steno-2 result. Searches of our copy for Steno, 7.8 years, and multifactorial intervention found no passage giving the claimed duration or approximately halved risk. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
  • Premisecitation

    Intensified multifactorial intervention with tight glucose regulation and the use of renin-angiotensin system blockers, aspirin, and lipid-lowering agents has been shown to reduce the risk of nonfatal cardiovascular disease among patients with type 2 diabetes mellitus and microalbuminuria.

    “Intensified multifactorial intervention -with tight glucose regulation and the use of renin-angiotensin system blockers, aspirin, and lipid-lowering agents -has been shown to reduce the risk of nonfatal cardiovascular disease among patients with type 2 diabetes mellitus and microalbuminuria.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [10] source

      The CVD section (page unavailable) says reducing cardiovascular risk factors can prevent or slow CVD and reports cardiovascular benefits from lipid-lowering and blood-pressure treatment. The antiplatelet section also reports that aspirin helps prevent cardiovascular events. The copy does not establish that the specified combined intervention reduced nonfatal CVD specifically in patients with type 2 diabetes and microalbuminuria. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Findingcitation

    Few serious adverse effects were reported during regular interviews with patients.

    “However, few serious adverse effects were reported during regular interviews with patients.10,12”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [10] source

      The ‘C. Older individuals’ section discusses the risk of serious adverse effects from hypoglycemia, but does not report how many adverse effects occurred. Searches for regular patient interviews and reports of few serious adverse effects found no passage addressing either point. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [12]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Findingown data

    Progression of diabetic retinopathy occurred in 41 patients in the intensive-therapy group and in 54 patients in the conventional-therapy group (relative risk, 0.57; 95% CI, 0.37 to 0.88; P = 0.01).

    “Progression of diabetic retinopathy occurred in 41 patients in the intensive-therapy group and in 54 patients in the conventional-therapy group (relative risk, 0.57; 95% CI, 0.37 to 0.88; P = 0.01).”
    Quote in the paperNot a substantial claim
  • May combine two claims. 26
  • Classified as probably not a substantial claim. 26
  • The quote only partly states this claim. 1

  • May combine two claims.

    Premisecitation

    In secondary interventions, individual therapy with aspirin, antihypertensive agents, and lipid-lowering drugs each reduced the relative risk of cardiovascular events by about 25%, and the effects appeared to be additive.

    “hypertensive agents, and lipid-lowering drugs each reduced the relative risk of cardiovascular events by about 25%, and the effects appeared to be additive.21,22”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [21] source
    • cites [22] source

      The Results section says that medications lowering cholesterol and blood pressure are proven interventions that reduce cardiovascular risk. It does not report a roughly 25% reduction for each drug class, address aspirin’s effect, or say the effects are additive. No page number is available in our copy. (LLM, conf=0.80)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data

    During 13.3 years of follow-up, 24 patients in the intensive-therapy group died, as compared with 40 in the conventional-therapy group, with a hazard ratio for death of 0.54 (95% CI, 0.32 to 0.89; P = 0.02).

    “Twenty-four patients in the intensive-therapy group died, as compared with 40 in the conventional-therapy group (hazard ratio, 0.54; 95% confidence interval [CI], 0.32 to 0.89; P = 0.02).”
    • Also stated in: § 586 · plain
      “During the entire 13.3 years of follow-up, 24 patients (30%) in the intensive-therapy group died, as compared with 40 patients (50%) in the conventional-therapy group, which corresponded to an absolute risk reduction of 20% (P = 0.02 by the log-rank test) (Fig. 3A).”
    • Also stated in: § 586 · plain
      “The hazard ratio for death in the intensive-therapy group, as compared with the conventional-therapy group, was 0.54 (95% confidence interval [CI], 0.32 to 0.89; P = 0.02).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    A total of 209 cardiovascular events occurred during the 13.3 years of observation.

    “A total of 209 cardiovascular events occurred during the 13.3 years of observation (Table 2 and Fig. 3B).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Deaths from cancer were as expected on the basis of data from the Danish Cancer Registry and did not differ significantly between the two study groups (two deaths in the intensive-therapy group and five in the conventional-therapy group).

    “Deaths from cancer were as expected on the basis of data from the Danish Cancer Registry and did not differ significantly between the two study groups (two deaths in the intensivetherapy group and five in the conventional-therapy group).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    No significant differences were observed between the two groups with respect to habits related to exercise and smoking, and only minor (although significant) changes were seen in the intake of carbohydrates and fat.

    “No significant differences were observed between the two groups with respect to habits related to exercise and smoking, and only minor (although significant) changes were seen in the intake of carbohydrates and fat.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    There were no significant differences in body weight or waist circumference between the two groups.

    “There were also no significant differences in body weight or waist circumference (Table 1).”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    Risk factors in the intensive-therapy group remained the same as they had been during the original trial, except for systolic blood pressure, which increased (P = 0.001).

    “In contrast, risk factors in the intensive-therapy group remained the same as they had been during the original trial, except for systolic blood pressure, which increased”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The hazard ratio for death from cardiovascular disease tended to decrease in the intensive-therapy group after the end of the original trial, but the difference between the groups did not reach significance (P = 0.06).

    “The hazard ratio for death from cardiovascular disease tended to decrease in the intensive-therapy group after the end of the original trial, but the difference between the groups did not reach significance (P = 0.06).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Reductions in the progression of microvascular complications occurred after a mean of 3.8 years of intensified intervention, and these changes were maintained at 13.3 years.

    “Reductions in the progression of microvascular complications occurred after a mean of 3.8 years of intensified intervention, 12 changes that were maintained at 13.3 years.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingown data

    During the 13.3 years of observation, at least one minor episode of symptomatic hypoglycemia was reported in 80% of patients in the intensive-therapy group and in 70% of patients in the conventional-therapy group (P = 0.15).

    “During the 13.3 years of observation, at least one minor episode of symptomatic hypoglycemia was reported in 80% of patients in the intensivetherapy group and in 70% of patients in the conventional-therapy group (P = 0.15).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Two patients in the intensive-therapy group and one in the conventional-therapy group reported having muscle pain after statin treatment; however, no elevation of the serum creatine kinase level was seen.

    “Two patients in the intensive-therapy group and one in the conventional-therapy group reported having muscle pain after statin treatment; however, no elevation of the serum creatine kinase level was seen.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Only the control of systolic blood pressure deteriorated in the intensive-therapy group, whereas glucose levels, lipid levels, diastolic blood pressure, and the rate of urinary albumin excretion improved in the conventional-therapy group, leaving the two study groups with similar levels of risk factors after 13.3 years.

    “Only the control of systolic blood pressure deteriorated in the intensive-therapy group, whereas glucose levels, lipid levels, diastolic blood pressure, and the rate of urinary albumin excretion improved in the conventional-therapy group, leaving the two study groups with similar levels of risk factors after 13.3 years.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The average number of physician-prescribed drugs for type 2 diabetes or its complications in the intensive-therapy group at the end of the follow-up period was 5.5, as compared with 5.7 in the conventional-therapy group (P = 0.64).

    “The average number of physicianprescribed drugs for type 2 diabetes or its complications in the intensive-therapy group at the end of the follow-up period was 5.5, as compared with 5.7 in the conventional-therapy group (P = 0.64).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In the trial, the reductions in risk in the composite of cardiovascular events were a 59% reduction in relative risk and a 29% reduction in absolute risk.

    “Therefore, the reductions in riska 59% reduction in the relative risk and a 29% reduction in the absolute risk -in the composite of cardiovascular events fit with projections from trials involving single risk factors.21”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    A bleeding gastric ulcer developed in one patient in the intensive-therapy group.

    “A bleeding gastric ulcer developed in one patient in the intensive-therapy group.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Five patients in the intensive-therapy group and four patients in the conventional-therapy group reported having a cough during treatment with angiotensin-converting-enzyme inhibitors; the cough disappeared in all patients after a change to an angiotensin II antagonist.

    “Five patients in the intensive-therapy group and four patients in the conventional-therapy group reported having a cough during treatment with angiotensin-converting-enzyme inhibitors.The cough disappeared in all patients after a change to an angiotensin II antagonist.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The drugs used in the study differed between the study groups; a larger proportion of patients in the intensive-therapy group took metformin or sulfonylurea, despite similar levels of glycemia in the two groups.

    “The drugs used in our study differed between the study groups.For instance, a larger proportion of patients in the intensive-therapy group took metformin or sulfonylurea, despite the similar levels of glycemia in the two groups.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The rate of death among patients with type 2 diabetes is approximately twice as high as that among persons without the disorder.

    “The rate of death among patients with type 2 diabetes is approximately twice as high as that among persons without the disorder.2,3”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [2] source
    • cites [3] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    It was estimated that the plan for analyzing death from any cause would provide a statistical power of 0.75 and a type I error rate of 0.05 in detecting a reduction in the relative risk of death of 40% in the intensive-therapy group.

    “It was estimated that this plan for analyzing death from any cause would provide a statistical power of 0.75 and a type I error rate of 0.05 in detecting a reduction in the relative risk of death of 40% in the intensive-therapy group.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The need for laser treatment of either proliferative retinopathy or macular edema was evaluated by ophthalmologists at the eye clinic of the Steno Diabetes Center, who were unaware of study-group assignments.

    “The need for laser treatment of either proliferative retinopathy or macular edema was evaluated by ophthalmologists at the eye clinic of the Steno Diabetes Center, who were unaware of study-group assignments.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Data regarding tertiary end points were censored according to prespecified intervals and analyzed with a proportional-hazards model, with adjustment for age, duration of diabetes, sex, and microvascular status at baseline.

    “Data regarding tertiary end points were censored according to prespecified intervals and analyzed with the use of a proportional-hazards model, with adjustment for age, duration of diabetes, sex, and microvascular status at baseline; these results are expressed as relative risks.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    An independent committee whose members were unaware of study-group assignments from the intervention portion of the Steno-2 Study adjudicated the specified end points.

    “An independent committee whose members were unaware of study-group assignments from the intervention portion of the Steno-2 Study adjudicated the specified end points.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    In at-risk patients with type 2 diabetes, intensive intervention with multiple drug combinations and behavior modification had sustained beneficial effects with respect to vascular complications and on rates of death from any cause and from cardiovascular causes.

    “In at-risk patients with type 2 diabetes, intensive intervention with multiple drug combinations and behavior modification had sustained beneficial effects with respect to vascular complications and on rates of death from any cause and from cardiovascular causes.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The mortality benefit observed during the observational follow-up is attributable to the original randomized intensive therapy, despite the conventional-therapy group receiving intensified treatment after the trial and the narrowing of risk-factor differences.
    • Rests on an assumption: The results from this trial population of white Danish patients with type 2 diabetes and persistent microalbuminuria generalize to the broader population of at-risk patients with type 2 diabetes.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The measurements were obtained by a single laboratory technician who was not aware of the original study-group assignments.

    “The measurements were obtained by a single laboratory technician who was not aware of the original studygroup assignments.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Three patients withdrew during follow-up because they moved to other regions: one patient in the intensive-therapy group withdrew after 3.2 years, and two patients in the conventional-therapy group withdrew after 0.4 and 4.7 years.

    “Three patients withdrew during follow-up because they moved to other regions: one patient in the intensive-therapy group withdrew after 3.2 years, and two patients in the conventional-therapy group withdrew after 0.4 and 4.7 years.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Of the 160 patients enrolled in the Steno-2 Study, 27 died and 3 (including 1 patient in the intensive-therapy group) withdrew before the end-of-trial examinations in 2001.

    “Of the 160 patients who were enrolled in the Steno-2 Study, 27 died and 3 (including 1 patient in the intensive-therapy group) withdrew before the end-of-trial examinations in 2001.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    The protocol for the follow-up trial specified that no analyses of death from any cause would be performed until at least 60 patients had died, as verified by online death registration, and until at least half the patients in either the intensive-therapy group or the conventional-therapy group had died.

    “The protocol for the follow-up trial specified that no analyses of death from any cause would be performed until at least 60 patients had died, as verified by online death registration, and until at least half the patients in either the intensive-therapy group or the conventional-therapy group had died.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Diabetic retinopathy was graded according to the six-level EURODIAB grading scale by two independent eye specialists who were unaware of the patients' study-group assignments.

    “Diabetic retinopathy was graded according to the six-level grading scale of the European Community-funded Concerted Action Programme into the Epidemiology and Prevention of Diabetes (EURODIAB) by two independent eye specialists who were unaware of the patients' study-group assignments”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    All end points were analyzed according to the intention-to-treat principle.

    “All end points were analyzed according to the intention-to-treat principle.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    No other patients were lost to follow-up.

    “No other patients were lost to follow-up.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    At follow-up examination, 84% of patients in the intensive-therapy group and 87% of those in the conventional-therapy group were still being treated at diabetes clinics.

    “At follow-up examination, 84% of patients in the intensive-therapy group and 87% of those in the conventional-therapy group were still being treated at diabetes clinics.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Type 2 diabetes mellitus is associated with a high rate of complications related to cardiovascular disease and diabetic nephropathy, retinopathy, and neuropathy.

    “T ype 2 diabetes mellitus is associated with a high rate of complications related to cardiovascular disease and diabetic nephropathy, retinopathy, and neuropathy.[1][2][3]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [1] source
    • cites [2] source
    • cites [3] source

  • May combine two claims.

    Premisecitation

    In the DCCT follow-up trial, glucose regulation deteriorated in the original intensive-therapy group and improved in the control group, resulting in a convergence of the glycemic levels in the two groups.

    “In the DCCT follow-up trial, glucose regulation deteriorated in the original intensive-therapy group and improved in the control group, resulting in a convergence of the glycemic levels in the two groups.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    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”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Recent surveys have shown very slow progress in achieving treatment goals and in the use of recommended drugs for the prevention of diabetic vascular complications.

    “Recent surveys have shown very slow progress in achieving treatment goals and in the use of recommended drugs for the prevention of diabetic vascular complications.31,32”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [31]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [32]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationown data

    Intensive, multifactorial care of patients with type 2 diabetes leads to reduced rates of death and cardiovascular disorders.

    “Therefore, since intensive, multifactorial care of patients with type 2 diabetes leads to reduced rates of death and cardiovascular disorders, the early and meticulous implementation of current treatment guidelines remains a major challenge.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The effect of blood-pressure reduction on cardiovascular end points usually occurs within months, whereas the effect of lipid lowering is evident after 1 to 2 years.

    “The effect of blood-pressure reduction on cardiovascular end points usually occurs within months, 26,27 whereas the effect of lipid lowering is evident after 1 to 2 years.8,28,29”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [26] source
    • cites [27] source
    • cites [8] source
    • cites [28] source
    • cites [29] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Dialysis need is a condition that in many parts of the world is tantamount to death.

    “Indeed, during continuous follow-up, this reduction translated into a significant absolute risk reduction of 6.3% in the need for dialysis, a condition that in many parts of the world is tantamount to death.30”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    It is mandatory by law for a physician to complete a death certificate for any death occurring in Denmark, and the data are coded and retained in the computerized Danish Death Registry.

    “It is man-datory by law for a physician to complete a death certificate for any death occurring in Denmark; the data are coded and retained in the computerized Danish Death Registry.16”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [16]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study did not monitor adverse effects continuously.

    “We did not monitor adverse effects continuously.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    After an average follow-up of 17 years in the DCCT follow-up trial, the original intensive-therapy treatment was associated with an absolute risk reduction of 2.8% for a composite cardiovascular end point.

    “After an average follow-up of 17 years, the original intensive-therapy treatment was associated with an absolute risk reduction of 2.8% for a composite cardiovascular end point.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study was not designed to identify which elements of intensive diabetes therapy contributed most to the reduction in cardiovascular risk.

    “Our study was not designed to identify which elements of intensive diabetes therapy contributed most to the reduction in cardiovascular risk.”
    Quote in the paperNot a substantial claim
42 of 42

  • The paper relies on this without support.

    The mortality benefit observed during the observational follow-up is attributable to the original randomized intensive therapy, despite the conventional-therapy group receiving intensified treatment after the trial and the narrowing of risk-factor differences.

    “At the end of the follow-up period, the differences in risk factors between the groups had narrowed, primarily because of intensified treatment among patients in the original conventional-therapy group (Fig. 1A).”

  • The paper relies on this without support.

    The results from this trial population of white Danish patients with type 2 diabetes and persistent microalbuminuria generalize to the broader population of at-risk patients with type 2 diabetes.

    “In at-risk patients with type 2 diabetes, intensive intervention with multiple drug combinations and behavior modification had sustained beneficial effects with respect to vascular complications and on rates of death from any cause and from cardiovascular causes.”
2 of 2

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?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Insulin-plus-oral therapy exceeds insulin use

    Minor

    At the end of follow-up in the intensive-therapy group, 83% are reported as using insulin plus an oral hypoglycemic agent, but only 73% are reported as using insulin. Combination users must be a subset of insulin users.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. Beck-Nielsen H, 2000, Ugeskr Laeger, 162, S1
  2. Juel K, 1999, Dan Med Bull, 46, 354
  3. Gaede PH, 2006, Dan Med Bull, 53, 258

Cited by

Sorted by citations

Related

Authors
Gæde, P., Lund-Andersen, H., Parving, H.-H., & Pedersen, O.
Affiliations
  • Steno Diabetes Center Copenhagen (DK)
  • Aarhus University (DK)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2008-02-07
Volume
358
Issue
6
Pages
580-591
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa0706245
OpenAlex
W2170271198
Cited by
3,489
References
36
Citations by year
2026: 54 · 2025: 77 · 2024: 99 · 2023: 131 · 2022: 124 · 2021: 170 · 2020: 184 · 2019: 160 · 2018: 181 · 2017: 176 · 2016: 207 · 2015: 203 · 2014: 253 · 2013: 237 · 2012: 251
FWCI
164.82
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
Topics
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
Keywords
type 2 diabetes, tight glycemic control, multifactorial intervention, microalbuminuria, cardiovascular mortality, all-cause mortality, renin-angiotensin system inhibitors, aspirin
MeSH terms
Aged, Angiotensin-Converting Enzyme Inhibitors, Hypolipidemic Agents, Aspirin, Behavior Therapy, Cardiovascular Diseases, Cause of Death

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Cited sources are checked by gpt-6-sol.

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 ›

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