Diabetes Care
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Abraira, C.
Right arrow Articles by Lee, H. S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Abraira, C.
Right arrow Articles by Lee, H. S.
Social Bookmarking
Add to CiteULike   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?

Diabetes Care, Vol 18, Issue 8 1113-1123, Copyright © 1995 by American Diabetes Association

ARTICLES

Veterans Affairs Cooperative Study on glycemic control and complications in type II diabetes (VA CSDM). Results of the feasibility trial. Veterans Affairs Cooperative Study in Type II Diabetes

C Abraira, JA Colwell, FQ Nuttall, CT Sawin, NJ Nagel, JP Comstock, NV Emanuele, SR Levin, W Henderson and HS Lee
Department of Veterans Affairs Cooperative Studies Program, Hines, Illinois, USA.

OBJECTIVE--It is not clear whether intensive pharmacological therapy can be effectively sustained in non-insulin-dependent diabetes mellitus (NIDDM). The relative risks and benefits of intensive insulin therapy in NIDDM are not well defined. Accordingly, we designed a feasibility study that compared standard therapy and intensive therapy in a group of NIDDM men who required insulin due to sustained hyperglycemia. RESEARCH DESIGN AND METHODS--A prospective trial was conducted in five medical centers in 153 men of 60 +/- 6 years of age who had a known diagnosis of diabetes for 7.8 +/- 4 years. They were randomly assigned to a standard insulin treatment group (one morning injection per day) or to an intensive therapy group designed to attain near-normal glycemia and a clinically significant separation of glycohemoglobin from the standard arm. A four-step plan was used in the intensive therapy group along with daily self-monitoring of glucose: 1) an evening insulin injection, 2) the same injection adding daytime glipizide, 3) two injections of insulin alone, and 4) multiple daily injections. Patient accrual and adherence, glycohemoglobin (HbA1c), side effects, and measurements of endpoints for a prospective long-term trial were assessed. RESULTS--Accrual goals were met, mean follow-up time was 27 months (range 18-35 months), and patients kept 98.6% of scheduled visits. After 6 months, the mean HbA1c in the intensive therapy group was at or below 7.3% and remained 2% lower than the standard group for the duration of the trial. Most of the decrease in the mean HbA1c in the intensive group was obtained by a single injection of evening intermediate insulin, alone or with daytime glipizide. By the end of the trial, 64% of the patients had advanced to two or more injections of insulin a day, aiming for normal HbA1c. However, only a small additional fall in HbA1c was attained. Severe hypoglycemia was rare (two events per 100 patients per year) and not significantly different between the groups, nor were changes in weight, blood pressure, or plasma lipids. There were 61 new cardiovascular events in 40 patients and 10 deaths (6 due to cardiovascular causes). CONCLUSIONS--Intense stepped insulin therapy in NIDDM patients who have failed glycemic control on pharmacological therapy is effective in maintaining near-normal glycemic control for > 2 years without excessive severe hypoglycemia, weight gain, hypertension, or dyslipidemia. Cardiovascular event rates are high at this stage of NIDDM. A long-term prospective trial is needed to assess the risk-benefit ratio of intensified treatment of hyperglycemia in NIDDM patients requiring insulin.
Add to CiteULike CiteULike   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 Cleveland Clinic Journal of MedicineHome page
B. J. HOOGWERF
Does intensive therapy of type 2 diabetes help or harm? Seeking accord on ACCORD.
Cleveland Clinic Journal of Medicine, October 1, 2008; 75(10): 729 - 737.
[Abstract] [Full Text] [PDF]

Home page
 CJASNHome page
C. Abaterusso, A. Lupo, V. Ortalda, V. De Biase, A. Pani, M. Muggeo, and G. Gambaro
Treating Elderly People with Diabetes and Stages 3 and 4 Chronic Kidney Disease
Clin. J. Am. Soc. Nephrol., July 1, 2008; 3(4): 1185 - 1194.
[Abstract] [Full Text] [PDF]

Home page
 Diabetes CareHome page
J. C. Pickup and E. Renard
Long-Acting Insulin Analogs Versus Insulin Pump Therapy for the Treatment of Type 1 and Type 2 Diabetes
Diabetes Care, February 1, 2008; 31(Supplement_2): S140 - S145.
[Abstract] [Full Text] [PDF]

Home page
 Diabetes CareHome page
Z. T. Bloomgarden
Exploring Treatment Strategies for Type 2 Diabetes
Diabetes Care, October 1, 2007; 30(10): 2737 - 2745.
[Full Text] [PDF]

Home page
 Diabetes CareHome page
P. E. Cryer
Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy: A Consensus Statement From the American Diabetes Association and the European Association for the Study of Diabetes: Response to Nathan et al.
Diabetes Care, January 1, 2007; 30(1): 190 - 192.
[Full Text] [PDF]

Home page
 Diabetes CareHome page
D. M. Nathan, J. B. Buse, M. B. Davidson, R. J. Heine, R. R. Holman, R. Sherwin, and B. Zinman
Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy: A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes
Diabetes Care, August 1, 2006; 29(8): 1963 - 1972.
[Full Text] [PDF]

Home page
 Diabetes CareHome page
N. N. Zammitt and B. M. Frier
Hypoglycemia in Type 2 Diabetes: Pathophysiology, frequency, and effects of different treatment modalities
Diabetes Care, December 1, 2005; 28(12): 2948 - 2961.
[Full Text] [PDF]

Home page
 Clin. DiabetesHome page
I. B. Hirsch, R. M. Bergenstal, C. G. Parkin, E. Wright Jr., and J. B. Buse
A Real-World Approach to Insulin Therapy in Primary Care Practice
Clin. Diabetes, April 1, 2005; 23(2): 78 - 86.
[Full Text] [PDF]

Home page
 Arch Intern MedHome page
G. H. Murata, R. M. Hoffman, J. H. Shah, C. S. Wendel, and W. C. Duckworth
A Probabilistic Model for Predicting Hypoglycemia in Type 2 Diabetes Mellitus: The Diabetes Outcomes in Veterans Study (DOVES)
Arch Intern Med, July 12, 2004; 164(13): 1445 - 1450.
[Abstract] [Full Text] [PDF]

Home page
 Journal of Pharmacy PracticeHome page
G. Vincze and A. Parthan
The Value of Home Monitoring Kits in Diabetes, Hypertension, Asthma, and Oral Anticoagulation Therapy
Journal of Pharmacy Practice, June 1, 2004; 17(3): 182 - 196.
[Abstract] [PDF]

Home page
 Clin. DiabetesHome page
K. B. Campbell and S. S. Braithwaite
Hospital Management of Hyperglycemia
Clin. Diabetes, April 1, 2004; 22(2): 81 - 88.
[Full Text] [PDF]

Home page
 Arch Intern MedHome page
S. B. Soumerai, C. Mah, F. Zhang, A. Adams, M. Barton, V. Fajtova, and D. Ross-Degnan
Effects of Health Maintenance Organization Coverage of Self-monitoring Devices on Diabetes Self-care and Glycemic Control
Arch Intern Med, March 22, 2004; 164(6): 645 - 652.
[Abstract] [Full Text] [PDF]

Home page
 British Journal of Diabetes & Vascular DiseaseHome page
S. Gardner, S. J Dunachie, and J. C Levy
Real gains but practical limitations to glycaemic control with insulin in type 2 diabetes
The British Journal of Diabetes & Vascular Disease, March 1, 2004; 4(2): 98 - 102.
[Abstract] [PDF]

Home page
 Arch Intern MedHome page
S. A. Westphal and P. J. Palumbo
Insulin and Oral Hypoglycemic Agents Should Not Be Used in Combination in the Treatment of Type 2 Diabetes
Arch Intern Med, August 11, 2003; 163(15): 1783 - 1785.
[Full Text] [PDF]

Home page
 Arch Intern MedHome page
N. Kagansky, S. Levy, E. Rimon, L. Cojocaru, A. Fridman, Z. Ozer, and H. Knobler
Hypoglycemia as a Predictor of Mortality in Hospitalized Elderly Patients
Arch Intern Med, August 11, 2003; 163(15): 1825 - 1829.
[Abstract] [Full Text] [PDF]

Home page
 Diabetes CareHome page
P. E. Cryer, S. N. Davis, and H. Shamoon
Hypoglycemia in Diabetes
Diabetes Care, June 1, 2003; 26(6): 1902 - 1912.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
D. E. DeWitt and I. B. Hirsch
Outpatient Insulin Therapy in Type 1 and Type 2 Diabetes Mellitus: Scientific Review
JAMA, May 7, 2003; 289(17): 2254 - 2264.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
D. E. DeWitt and D. C. Dugdale
Using New Insulin Strategies in the Outpatient Treatment of Diabetes: Clinical Applications
JAMA, May 7, 2003; 289(17): 2265 - 2269.
[Abstract] [Full Text] [PDF]

Home page
 Diabetes CareHome page
C. Desouza, H. Salazar, B. Cheong, J. Murgo, and V. Fonseca
Association of Hypoglycemia and Cardiac Ischemia: A study based on continuous monitoring
Diabetes Care, May 1, 2003; 26(5): 1485 - 1489.
[Abstract] [Full Text] [PDF]

Home page
 Diabetes CareHome page
G. P. Leese, J. Wang, J. Broomhall, P. Kelly, A. Marsden, W. Morrison, B. M. Frier, and A. D. Morris
Frequency of Severe Hypoglycemia Requiring Emergency Treatment in Type 1 and Type 2 Diabetes: A population-based study of health service resource use
Diabetes Care, April 1, 2003; 26(4): 1176 - 1180.
[Abstract] [Full Text] [PDF]

Home page
 ANN INTERN MEDHome page
R. Harris, K. Donahue, S. S. Rathore, P. Frame, S. H. Woolf, and K. N. Lohr
Screening Adults for Type 2 Diabetes: A Review of the Evidence for the U.S. Preventive Services Task Force
Ann Intern Med, February 4, 2003; 138(3): 215 - 229.
[Abstract] [Full Text] [PDF]

Home page
 J Clin PharmacolHome page
D. Devineni, Y. H. Walter, H. T. Smith, J. S. Lee, P. Prasad, and J. F. McLeod
Pharmacokinetics of Nateglinide in Renally Impaired Diabetic Patients
J. Clin. Pharmacol., February 1, 2003; 43(2): 163 - 170.
[Abstract] [Full Text]

Home page
 Arch Intern MedHome page
A. D. Mooradian
Cardiovascular Disease in Type 2 Diabetes Mellitus: Current Management Guidelines
Arch Intern Med, January 13, 2003; 163(1): 33 - 40.
[Abstract] [Full Text] [PDF]

Home page
 Arch Intern MedHome page
I. M. El-Kebbi, C. B. Cook, D. C. Ziemer, C. D. Miller, D. L. Gallina, and L. S. Phillips
Association of Younger Age With Poor Glycemic Control and Obesity in Urban African Americans With Type 2 Diabetes
Arch Intern Med, January 13, 2003; 163(1): 69 - 75.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
D. M. Nathan
Initial Management of Glycemia in Type 2 Diabetes Mellitus
N. Engl. J. Med., October 24, 2002; 347(17): 1342 - 1349.
[Full Text] [PDF]

Home page
 DiabetesHome page
A. S. Attele, Y.-P. Zhou, J.-T. Xie, J. A. Wu, L. Zhang, L. Dey, W. Pugh, P. A. Rue, K. S. Polonsky, and C.-S. Yuan
Antidiabetic Effects of Panax ginseng Berry Extract and the Identification of an Effective Component
Diabetes, June 1, 2002; 51(6): 1851 - 1858.
[Abstract] [Full Text] [PDF]

Home page
 DiabetesHome page
S. A. Segel, D. S. Paramore, and P. E. Cryer
Hypoglycemia-Associated Autonomic Failure in Advanced Type 2 Diabetes
Diabetes, March 1, 2002; 51(3): 724 - 733.
[Abstract] [Full Text] [PDF]

Home page
 Diabetes Spectr.Home page
P. E. Cryer and B. P. Childs
Negotiating the Barrier of Hypoglycemia in Diabetes
Diabetes Spectr, January 1, 2002; 15(1): 20 - 27.
[Abstract] [Full Text] [PDF]

Home page
 DiabetesHome page
L. Laviola, G. Belsanti, A. M. Davalli, R. Napoli, S. Perrini, G. C. Weir, R. Giorgino, and F. Giorgino
Effects of Streptozocin Diabetes and Diabetes Treatment by Islet Transplantation on In Vivo Insulin Signaling in Rat Heart
Diabetes, December 1, 2001; 50(12): 2709 - 2720.
[Abstract] [Full Text] [PDF]

Home page
 Arch Intern MedHome page
C. D. Miller, L. S. Phillips, D. C. Ziemer, D. L. Gallina, C. B. Cook, and I. M. El-Kebbi
Hypoglycemia in Patients With Type 2 Diabetes Mellitus
Arch Intern Med, July 9, 2001; 161(13): 1653 - 1659.
[Abstract] [Full Text] [PDF]

Home page
 Arch Intern MedHome page
I. M. El-Kebbi, D. C. Ziemer, C. B. Cook, C. D. Miller, D. L. Gallina, and L. S. Phillips
Comorbidity and Glycemic Control in Patients With Type 2 Diabetes
Arch Intern Med, May 28, 2001; 161(10): 1295 - 1300.
[Abstract] [Full Text] [PDF]

Home page
 DiabetesHome page
R. Halse, S. L. Pearson, J. G. McCormack, S. J. Yeaman, and R. Taylor
Effects of Tumor Necrosis Factor-{alpha} on Insulin Action in Cultured Human Muscle Cells
Diabetes, May 1, 2001; 50(5): 1102 - 1109.
[Abstract] [Full Text]

Home page
 Diabetes CareHome page
R. G. Hiss, M. L. Gillard, B. A. Armbruster, and L. A. McClure
Comprehensive Evaluation of Community-Based Diabetic Patients: Effect of feedback to patients and their physicians: a randomized controlled trial
Diabetes Care, April 1, 2001; 24(4): 690 - 694.
[Abstract] [Full Text]

Home page
 J. Clin. Endocrinol. Metab.Home page
S. T. Azar, I. Salti, M. S. Zantout, and S. Major
Alterations in Plasma Transforming Growth Factor {beta} in Normoalbuminuric Type 1 and Type 2 Diabetic Patients
J. Clin. Endocrinol. Metab., December 1, 2000; 85(12): 4680 - 4682.
[Abstract] [Full Text]

Home page
 ANN INTERN MEDHome page
I. Saito, A. R. Folsom, F. L. Brancati, B. B. Duncan, L. E. Chambless, and P. G. McGovern
Nontraditional Risk Factors for Coronary Heart Disease Incidence among Persons with Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study
Ann Intern Med, July 18, 2000; 133(2): 81 - 91.
[Abstract] [Full Text] [PDF]

Home page
 ANN INTERN MEDHome page
R. A. DeFronzo
Pharmacologic Therapy for Type 2 Diabetes Mellitus
Ann Intern Med, August 17, 1999; 131(4): 281 - 303.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
R. C. Turner, C. A. Cull, V. Frighi, R. R. Holman, and for the UK Prospective Diabetes Study Group
Glycemic Control With Diet, Sulfonylurea, Metformin, or Insulin in Patients With Type 2 Diabetes Mellitus: Progressive Requirement for Multiple Therapies (UKPDS 49)
JAMA, June 2, 1999; 281(21): 2005 - 2012.
[Abstract] [Full Text] [PDF]

Home page
 ANN INTERN MEDHome page
H. Yki-Jarvinen, L. Ryysy, K. Nikkila, T. Tulokas, R. Vanamo, and M. Heikkila
Comparison of Bedtime Insulin Regimens in Patients with Type 2 Diabetes Mellitus: A Randomized, Controlled Trial
Ann Intern Med, March 2, 1999; 130(5): 389 - 396.
[Abstract] [Full Text] [PDF]

Home page
 Arch Intern MedHome page
N. Emanuele, N. Azad, C. Abraira, W. Henderson, J. Colwell, S. Levin, F. Nuttall, J. Comstock, C. Sawin, C. Silbert, et al.
Effect of Intensive Glycemic Control on Fibrinogen, Lipids, and Lipoproteins: Veterans Affairs Cooperative Study in Type II Diabetes Mellitus
Arch Intern Med, December 1, 1998; 158(22): 2485 - 2490.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
The CDC Diabetes Cost-Effectiveness Study Group
The Cost-effectiveness of Screening for Type 2 Diabetes
JAMA, November 25, 1998; 280(20): 1757 - 1763.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
M. C. Riddle, D. M. Karl, J. M. Poothullil, M. J. Lenhard, I. B. Hirsch, T. C. Evans, B. Gaster, P. V. M. Cromme, J. C. Shipp, L. Jovanovic, et al.
Insulin Treatment for Type 2 Diabetes
JAMA, May 20, 1998; 279(19): 1523 - 1526.
[Full Text] [PDF]

Home page
 Arch Fam MedHome page
M. P. Stern
The Effect of Glycemic Control on the Incidence of Macrovascular Complications of Type 2 Diabetes
Arch Fam Med, March 1, 1998; 7(2): 155 - 162.
[Abstract] [Full Text] [PDF]

Home page
 CLIN PEDIATRHome page
K. L. Jones
Non-Insulin Dependent Diabetes in Children and Adolescents: The Therapeutic Challenge
Clinical Pediatrics, February 1, 1998; 37(2): 103 - 110.
[Abstract] [PDF]

Home page
 Arch Intern MedHome page
B. Gaster and I. B. Hirsch
The Effects of Improved Glycemic Control on Complications in Type 2 Diabetes
Arch Intern Med, January 26, 1998; 158(2): 134 - 140.
[Abstract] [Full Text] [PDF]

Home page
 ANN INTERN MEDHome page
C. M. Clark Jr. and F. Vinicor
Introduction
Ann Intern Med, January 1, 1996; 124(1_Part_2): 81 - 85.
[Full Text]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Diabetes Diabetes Care Clinical Diabetes Diabetes Spectrum
Copyright © 1995 by the American Diabetes Association.