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Drugs, Surgery Produce Similar Death Rates in Diabetics With Heart Disease

Posted on: Tuesday, 9 June 2009, 10:20 CDT

For patients with both Type 2 diabetes and heart disease, choosing drug therapy or surgery produces similar death rates, according to a new international, multicenter study.

Researchers at the University of Pittsburgh Graduate School of Public Health also found that even though prompt bypass surgery does not lower mortality rates for patients with severe heart disease, the surgery appears to lower the risk of subsequent major cardiac events, such as heart attacks or strokes.

The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) study recruited more than 2,300 patients from 49 clinical sites in the U.S. and abroad with both type 2 diabetes and stable heart disease who were under a physician's care to control their cholesterol and blood pressure . Some of the patients received drug therapy plus underwent prompt revascularization to restore blood flow -- either angioplasty to open blocked arteries or bypass surgery -- and some received drug therapy alone. Researchers also investigated which diabetes treatment strategy resulted in better outcomes -- insulin-providing or insulin-sensitizing.

The five-year survival rates did not differ significantly between the surgery group and the drug therapy group (88.3 percent versus 87.8 percent, respectively), researchers said. Also, the study's authors said there was no significant difference in survival between those receiving insulin-providing drugs (87.9 percent) and those who received insulin-sensitizing drugs (88.2 percent).

However, researchers found that 22.4 percent of patients who underwent surgery experienced another major cardiac event compared to 30.5 percent of those who received drug therapy alone. This benefit appeared to be greatest in those patients who underwent bypass surgery and received insulin-sensitizing drugs.

"(The results) indicate that when a patient with type 2 diabetes has more severe heart disease, it may be better to do bypass surgery early than to wait and simply treat with medication," Seth Genuth, M.D., the director of the diabetes management center of BARI 2D and a professor of medicine at Case Western Reserve University, was quoted as saying. "For patients with milder disease who are candidates for angioplasty, it is appropriate to treat with drug therapy first."


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