University of Pittsburgh leads major national study on treating patients who have diabetes and heart disease

June 14, 2001

PITTSBURGH, June 15 - Recruitment has begun at 14 out of an expected 40 centers for a monumental study that will determine the best way to treat patients who have early coronary artery disease (CAD) and type 2 diabetes. CAD is the number one killer of people with type 2 diabetes.

The University of Pittsburgh's Graduate School of Public Health (GSPH) is coordinating the study, which received a grant of more than $52.2 million from the National Heart, Lung and Blood Institute, $4.2 million from the National Institute of Diabetes and Digestive & Kidney Diseases and $15 million from Glaxo Smith Kline.

Known as the Bypass Angioplasty Revascularization Investigation 2D (BARI 2D), the study is comparing the effectiveness of various therapeutic regimens in reducing the number of deaths from CAD among type 2 diabetics. Investigators aim to determine whether aggressive drug therapy is more effective alone or in combination with surgery in reducing mortality in this population.

"The percentage of Americans who have been diagnosed with diabetes has doubled over the last 20 years, and that trend is expected to continue, partially due to the increase in obesity and sedentary lifestyles," said Katherine Detre, M.D., Dr. P.H., professor of epidemiology and director of the Epidemiology Data Center at the University of Pittsburgh GSPH, and principal investigator of the study. "The latest figures show that six to 10 percent of American adults ages 45 and older are diagnosed diabetic," she said. "However, it is believed that another six to 10 percent of American adults are diabetic but are unaware of it."

In type 2 diabetes, the body is unable to properly use insulin - a hormone needed to metabolize simple sugars. Such insulin resistance is a major risk factor for cardiovascular disease.

"Diabetics develop heart disease earlier than do non-diabetics and have lower survival rates," said David Kelley, M.D., professor of medicine in the division of endocrinology and metabolism and study co-principal investigator. "Some 90 to 95 percent of the world's diabetic patients have type 2, and 80 percent of them are overweight. Obesity appears to trigger the onset of this form of the disease."

With the help of 2,800 volunteer participants, the study will answer two questions that are critical to type 2 diabetic patients with stable coronary artery disease: Under what circumstances is it best to undergo revascularization in addition to drug therapy? and, Which method of drug therapy is best at controlling glucose?

BARI 2D is a follow-up to BARI, a study involving patients with more severe CAD. Dr. Detre reported on the results of BARI in the April 6, 2000, issue of the New England Journal of Medicine.

BARI 2D participants at each clinical site are randomly assigned to either aggressive drug therapy alone or to a combination treatment consisting of drug therapy and revascularization, either bypass surgery or angioplasty.

Participants are randomized further to either insulin provision or insulin sensitization to determine which method of glucose control is more effective. Insulin provision, which for decades has been the standard of care for type 2 diabetic patients, involves augmenting one's insulin store through daily injections or oral agents that stimulate insulin production.

This method will serve as the control against which a newer strategy - insulin sensitization - will be tested. Insulin sensitization uses drugs such as metformin or rosiglitazone to lessen the body's resistance to insulin, thus allowing the body to properly use the insulin it normally produces.

All patients will be followed for a minimum of five years to assess mortality, heart attack, stroke and other clinical events, angina, quality of life and cost of treatment. They will be on strict risk-factor management to control obesity, lipids and high blood pressure.

"Improving treatment for diabetic patients who have coronary artery disease is a priority in the field of cardiology today," said Howard Cohen, M.D., associate professor of medicine, associate chief in the division of cardiology, director of clinical services, associate director of cardiac catheterization labs and cardiology principal investigator of the Pittsburgh site. "The BARI 2D study will resolve ongoing questions about when coronary revascularization should be performed, or even if drug therapy without revascularization is the best option."
-end-
In addition to the University of Pittsburgh, sites for the BARI 2D study include academic medical centers across the United States and Canada. For more information about the BARI 2D trial and local clinical sites, access http://www.edc.gsph.pitt.edu/BARI2D.

The University of Pittsburgh ranks among the top 10 institutions in the United States in NIH funding, and the NIH award for BARI 2D represents one of the largest research grants ever received by the University.

Established in 1948, the GSPH at the University of Pittsburgh is world-renowned for contributions that have influenced public health practices and medical care for millions of people. It is the only fully accredited school of public health in the Commonwealth of Pennsylvania and is one of the top-ranked schools of public health in the United States. It is one of eight schools across the country to be designated a Public Health Training Center by the U.S. Department of Health and Human Services. For more information about the GSPH, access the school's website at http://www.pitt.edu/~gsphhome.

Contact: Frank Raczkiewicz
Phone: 412-624-2607
Fax: 412-624-3184
E-maill: RaczkiewiczFA@msx.upmc.edu

University of Pittsburgh Medical Center

Related Diabetes Articles from Brightsurf:

New diabetes medication reduced heart event risk in those with diabetes and kidney disease
Sotagliflozin - a type of medication known as an SGLT2 inhibitor primarily prescribed for Type 2 diabetes - reduces the risk of adverse cardiovascular events for patients with diabetes and kidney disease.

Diabetes drug boosts survival in patients with type 2 diabetes and COVID-19 pneumonia
Sitagliptin, a drug to lower blood sugar in type 2 diabetes, also improves survival in diabetic patients hospitalized with COVID-19, suggests a multicenter observational study in Italy.

Making sense of diabetes
Throughout her 38-year nursing career, Laurel Despins has progressed from a bedside nurse to a clinical nurse specialist and has worked in medical, surgical and cardiac intensive care units.

Helping teens with type 1 diabetes improve diabetes control with MyDiaText
Adolescence is a difficult period of development, made more complex for those with Type 1 diabetes mellitus (T1DM).

Diabetes-in-a-dish model uncovers new insights into the cause of type 2 diabetes
Researchers have developed a novel 'disease-in-a-dish' model to study the basic molecular factors that lead to the development of type 2 diabetes, uncovering the potential existence of major signaling defects both inside and outside of the classical insulin signaling cascade, and providing new perspectives on the mechanisms behind insulin resistance in type 2 diabetes and possibly opportunities for the development of novel therapeutics for the disease.

Tele-diabetes to manage new-onset diabetes during COVID-19 pandemic
Two new case studies highlight the use of tele-diabetes to manage new-onset type 1 diabetes in an adult and an infant during the COVID-19 pandemic.

Genetic profile may predict type 2 diabetes risk among women with gestational diabetes
Women who go on to develop type 2 diabetes after having gestational, or pregnancy-related, diabetes are more likely to have particular genetic profiles, suggests an analysis by researchers at the National Institutes of Health and other institutions.

Maternal gestational diabetes linked to diabetes in children
Children and youth of mothers who had gestational diabetes during pregnancy are at increased risk of diabetes themselves, according to new research published in CMAJ (Canadian Medical Association Journal).

Two diabetes medications don't slow progression of type 2 diabetes in youth
In youth with impaired glucose tolerance or recent-onset type 2 diabetes, neither initial treatment with long-acting insulin followed by the drug metformin, nor metformin alone preserved the body's ability to make insulin, according to results published online June 25 in Diabetes Care.

People with diabetes visit the dentist less frequently despite link between diabetes, oral health
Adults with diabetes are less likely to visit the dentist than people with prediabetes or without diabetes, finds a new study led by researchers at NYU Rory Meyers College of Nursing and East Carolina University's Brody School of Medicine.

Read More: Diabetes News and Diabetes Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.