The DOI matches its Crossref record; 42 of the 42 references it cites were found in a registry or an index; 5 of the 30 sources its claims cite were checked for support.
Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes
Open accessAbstract
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.)
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Claims the paper makes
5 of 30 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“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]”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Abstract
What the sources say
- Not checked — no full text of the sourcecites [4] source
- Supportedcites [5] source
The Discussion reports that tighter blood-pressure control in patients with hypertension and type 2 diabetes reduced the risk of diabetes-related complications. The Analyses of surrogate end points section also reports less deterioration in retinopathy, supporting the claim about progression. This paper establishes the point for blood pressure as a single risk factor, not for every intervention cited in the sentence. (LLM, conf=0.91)
- Not checked — no full text of the sourcecites [6] source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“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”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Abstract
What the sources say
- Could not verifycites [10] sourceExperimental — accuracy not yet measured
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)
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The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“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.”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Abstract
What the sources say
- Partly supportedcites [10] sourceExperimental — accuracy not yet measured
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)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Partly supported
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“However, few serious adverse effects were reported during regular interviews with patients.10,12”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Dis cus sion
What the sources say
- Could not verifycites [10] sourceExperimental — accuracy not yet measured
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)
- Not matchedcites [12]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Could not verify
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > 586
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“During the entire observation period, diabetic nephropathy developed in 20 patients in the intensive-therapy group, as compared with 37 patients in the conventional-therapy group (relative risk, 0.44; 95% CI, 0.25 to 0.77; P = 0.004) (Fig. 4).”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > 586
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The average number of recurrent events among patients with cardiovascular events was 2.0 in the intensive-therapy group and 3.3 in the conventional-therapy group.”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > 586
Strength:plain· not yet calibratedn = 48Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > R e sult s
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The mean number of major cardiovascular events was 0.6 in the intensive-therapy group and 2.0 in the conventional-therapy group.”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > 586
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
- It may state two separate claims as one. 26
- Probably not a substantial claim. 26
- The quote only partly states this claim. 1
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“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”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Dis cus sion
What the sources say
- Not checked — no full text of the sourcecites [21] source
- Partly supportedcites [22] sourceExperimental — accuracy not yet measured
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)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Also stated in: § 586 · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A total of 209 cardiovascular events occurred during the 13.3 years of observation (Table 2 and Fig. 3B).”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > 586
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > 586
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > 586
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There were also no significant differences in body weight or waist circumference (Table 1).”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > 586
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > R e sult s
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one. The quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > 586
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“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.”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Dis cus sion
What the sources say
- Not matchedcites [12]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Not matched
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > 586
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > 586
Strength:plain· not yet calibratedn = 2Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Dis cus sion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > 586
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Dis cus sion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A bleeding gastric ulcer developed in one patient in the intensive-therapy group.”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > 586
Strength:plain· not yet calibratedSingle caseTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > 586
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Dis cus sion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“The rate of death among patients with type 2 diabetes is approximately twice as high as that among persons without the disorder.2,3”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Abstract
What the sources say
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Statistical Analysis
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Procedures, Measurements, and End Points
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Statistical Analysis
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Procedures, Measurements, and End Points
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- 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.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The measurements were obtained by a single laboratory technician who was not aware of the original studygroup assignments.”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Procedures, Measurements, and End Points
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Procedures, Measurements, and End Points
Strength:plain· not yet calibratedn = 3Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Study Population
Strength:plain· not yet calibratedn = 160Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Statistical Analysis
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Procedures, Measurements, and End Points
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“All end points were analyzed according to the intention-to-treat principle.”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Statistical Analysis
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“No other patients were lost to follow-up.”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Procedures, Measurements, and End Points
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Study Population
Strength:plain· not yet calibratedn = 130Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“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]”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Abstract
What the sources say
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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.”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Dis cus sion
What the sources say
- Not checked — no full text of the sourcecites [25] source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“The study encompassed treatment goals similar to those recommended in the current guidelines of the American Diabetes Association.11”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Abstract
What the sources say
- Not checked — no full text of the sourcecites [11] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim could be matched to a paper in Crossref, so there is nothing to check it against.
In the paper
“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”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Dis cus sion
What the sources say
- Not matchedcites [31]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [32]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Dis cus sion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“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”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Dis cus sion
What the sources say
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“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”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Dis cus sion
What the sources say
- Not matchedcites [30]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
In the paper
“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”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Procedures, Measurements, and End Points
What the sources say
- Not matchedcites [16]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We did not monitor adverse effects continuously.”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Dis cus sion
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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.”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Dis cus sion
What the sources say
- Not checked — no full text of the sourcecites [25] source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Our study was not designed to identify which elements of intensive diabetes therapy contributed most to the reduction in cardiovascular risk.”
§ Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes > Dis cus sion
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
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.”
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?
The cited source says what the claim attributes to it.
In the citing paper
“Furthermore, large benefits are seen when multiple cardiovascular risk factors (glycemic, blood pressure, and lipid management) are addressed simultaneously, with evidence for long-lasting benefits (3)(4)(5).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [4]
The cited source says what the claim attributes to it.
In the citing paper
“large benefits are seen when multiple cardiovascular risk factors (glycemic, blood pressure, and lipid management) are addressed simultaneously, with evidence for long-lasting benefits (3–5).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [4]
The cited source says what the claim attributes to it.
In the citing paper
“Numerous studies have shown the efficacy of managing individual cardiovascular risk factors in preventing or slowing ASCVD in people with diabetes.”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [4]
The cited source says what the claim attributes to it.
In the citing paper
“Despite multifactorial treatment in the STENO-2 trial, renal disease still developed in 25% of patients over 13 years [15].”
In the citing paper
“Long-term follow-up (21 years from baseline) showed significantly reduced end-stage renal disease combined with death (HR 0.53; 95% CI, 0.35-0.80),and risk of HF hospitalization reduced by 70%.362”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [362]
In the citing paper
“After a further 5 years of observational follow-up this was associated with a significant reduction in cardiovascular mortality.456”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [456]
In the citing paper
“ASCVD morbidity and mortality have decreased (3,4).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2023 (2023) · cites this paper as [4]
In the citing paper
“Prolonged follow up showed that in some instances the benefit is retained for 10 years or more153–155”
From Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future (2014) · cites this paper as [155]
In the citing paper
“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 [814]
In the citing paper
“Large benefits are seen when multiple risk factors are addressed globally (154).”
From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [154]
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
MinorAt 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.
“| Insulin plus an oral hypoglycemic | 0 | 1 | 32 | 21 | 83 | 42 † |”
“| Insulin (%) | 6 | 14 | 57 | 54 | 73 | 82 |”
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“In the Steno-2 study [16], the difference in mean HbA1c levels between the conventional and intensive therapy groups after 7.”
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Metadata
- Authors
- Gæde, P., Lund-Andersen, H., Parving, H.-H., & Pedersen, O.
- Affiliations
- Steno Diabetes Center Copenhagen (DK)
- Aarhus University (DK)
- 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
- OpenAlex
- W2170271198
- Cited by
- 3,465
- References
- 36
- Citations by year
- 2026: 66 · 2025: 80 · 2024: 106 · 2023: 132 · 2022: 126 · 2021: 168 · 2020: 181 · 2019: 160 · 2018: 182 · 2017: 178 · 2016: 208 · 2015: 204 · 2014: 252 · 2013: 236 · 2012: 250
- FWCI
- 181.74
- 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) (submittedVersion)
- Funders
- Novo Nordisk
- 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, tight glycemic control, multifactorial intervention, microalbuminuria, cardiovascular mortality, all-cause mortality, renin-angiotensin system inhibitors, aspirin, lipid-lowering drugs, end-stage renal disease, retinal photocoagulation
- MeSH terms
- Aged, Angiotensin-Converting Enzyme Inhibitors, Hypolipidemic Agents, Aspirin, Behavior Therapy, Cardiovascular Diseases, Cause of Death, Combined Modality Therapy, Diabetes Mellitus, Type 2, Diabetic Neuropathies, Drug Therapy, Combination, Follow-Up Studies, Humans, Hypoglycemic Agents, Middle Aged, Platelet Aggregation Inhibitors, Risk Factors, Kaplan-Meier Estimate
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.
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