Drugs as good as surgery for diabetes and heart disease

There is no difference in mortality among patients with type 2 diabetes and stable heart disease who received prompt bypass surgery or  angioplasty compared to drug therapy alone, according to a landmark  study the University of Pittsburgh Graduate School of Public Health  presented at the American Diabetes Association annual Scientific  Sessions in New Orleans.

The BARI 2D study enrolled 2,368 patients with both type 2 diabetes and  stable heart disease who were under a physician's care to control their  cholesterol and blood pressure. Patients were randomized to receive drug  therapy and undergo prompt revascularization to restore blood flow -  either angioplasty to open blocked arteries or bypass surgery - or to  receive drug therapy alone. The investigators also looked at which of  two diabetes drug treatment strategies resulted in better outcomes  -  insulin-providing or insulin-sensitizing.

The results show that five-year survival rates did not differ  significantly between the revascularization group (88.3%) and the drug  therapy arm (87.8%). In addition, there was no significant difference in  survival between those who received insulin-providing drugs (87.9%) and  those who getting insulin-sensitizing drugs (88.2%). However, in the  group that received bypass surgery, the rate of all major cardiovascular  events was significantly lower (22.4%) compared to those who received  drug therapy alone (30.5%). This benefit appeared to be greatest in  people who underwent bypass and received insulin-sensitizing drugs.