TY - JOUR
T1 - Determinants of successful glycemic control among participants in the BARI 2D Trial
T2 - A Post-hoc Analysis
AU - Ismail-Beigi, Faramarz
AU - Lombardero, Manuel S.
AU - Escobedo, Jorge
AU - Genuth, Saul
AU - Green, Jennifer
AU - Massaro, Elaine
AU - Mooradian, Arshag D.
AU - Ovalle, Fernando
AU - Whitehouse, Fred
AU - Zonszein, Joel
N1 - Funding Information:
The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) is funded by the National Heart, Lung and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Diseases ( U01 HL061744 , U01 HL061746 , U01 HL061748 , U01 HL063804 ).
PY - 2014
Y1 - 2014
N2 - Objective The BARI 2D trial compared insulin provision (IP) versus insulin sensitization (IS) for the primary outcome of total mortality in participants with T2DM and cardiovascular disease (CVD). In this analysis we examine baseline characteristics that are associated with successful long-term glycemic control. Research design and methods In a 2 × 2 factorial design, 2368 participants were randomized to either IP or IS therapy, and to either prompt revascularization with medical therapy or medical therapy alone. Successful long-term glycemic control (success) was defined by simultaneously meeting 1) a mean HbA1c level of < 7.0% after each participant's third year of follow-up period, and 2) adherence with medications only from the assigned glycemic treatment arm during > 80% of the BARI 2D follow-up. The association between baseline variables and success was determined using unadjusted and adjusted logistic regression models. Results 1917 participants (962 IP and 955 IS participants) had sufficiently long follow-up and data for this analysis. Among these IP and IS participants, 235 and 335 participants met both criteria of success, respectively (p < 0.001). Those not on insulin at entry had higher odds of success (OR 2.25; CI 1.79-2.82) when treated with IS versus IP medications, irrespective of baseline HbA1c levels. Younger age, shorter duration of T2DM, and lower HbA1c at baseline were also each independently associated with higher success when treated with IS versus IP medications. Conclusion Patients similar to those in the BARI 2D trial may have a higher chance of achieving success with IS versus IP medications if they are younger, have shorter duration of T2DM, have lower HbA1c levels, have moderate or strenuous physically activity, and are not on insulin. In contrast, increasing age, longer duration of T2DM, higher HbA1c, and insulin therapy are associated with increased chance of success if treated with IP medications.
AB - Objective The BARI 2D trial compared insulin provision (IP) versus insulin sensitization (IS) for the primary outcome of total mortality in participants with T2DM and cardiovascular disease (CVD). In this analysis we examine baseline characteristics that are associated with successful long-term glycemic control. Research design and methods In a 2 × 2 factorial design, 2368 participants were randomized to either IP or IS therapy, and to either prompt revascularization with medical therapy or medical therapy alone. Successful long-term glycemic control (success) was defined by simultaneously meeting 1) a mean HbA1c level of < 7.0% after each participant's third year of follow-up period, and 2) adherence with medications only from the assigned glycemic treatment arm during > 80% of the BARI 2D follow-up. The association between baseline variables and success was determined using unadjusted and adjusted logistic regression models. Results 1917 participants (962 IP and 955 IS participants) had sufficiently long follow-up and data for this analysis. Among these IP and IS participants, 235 and 335 participants met both criteria of success, respectively (p < 0.001). Those not on insulin at entry had higher odds of success (OR 2.25; CI 1.79-2.82) when treated with IS versus IP medications, irrespective of baseline HbA1c levels. Younger age, shorter duration of T2DM, and lower HbA1c at baseline were also each independently associated with higher success when treated with IS versus IP medications. Conclusion Patients similar to those in the BARI 2D trial may have a higher chance of achieving success with IS versus IP medications if they are younger, have shorter duration of T2DM, have lower HbA1c levels, have moderate or strenuous physically activity, and are not on insulin. In contrast, increasing age, longer duration of T2DM, higher HbA1c, and insulin therapy are associated with increased chance of success if treated with IP medications.
KW - Cardiovascular disease
KW - Plasma insulin levels
KW - Predictors of glycemic control
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U2 - 10.1016/j.jdiacomp.2013.01.006
DO - 10.1016/j.jdiacomp.2013.01.006
M3 - Article
C2 - 23478173
AN - SCOPUS:84891832594
SN - 1056-8727
VL - 28
SP - 101
EP - 109
JO - Journal of Diabetes and Its Complications
JF - Journal of Diabetes and Its Complications
IS - 1
ER -
