After four years of follow-up, patients who had received intensive treatment during the trial had similar systolic blood pressure (BP) to those who had been on standard treatment but lower rates of cardiovascular (CV) events.
Patients with type 2 diabetes who had Roux-en-Y gastric bypass surgery maintained significant, although shrinking, improvements in HbA1c compared to those receiving lifestyle and medical management.
The researchers found an inverse association between insulin initiation and age, and black and Hispanic participants were less likely to have insulin initiated compared with white participants.
A cost-effectiveness analysis found that individualized control saved $13,547 per patient compared with uniform intensive control, primarily due to lower medication costs, and increased quality-adjusted life-years by 0.10.
Participants were randomized to receive either ezetimibe or placebo in addition to background simvastatin, and the subgroup of patients with diabetes was compared to those without the disease.
The most important predictors of the trajectory of glucose control were body mass index and levels of HbA1c and triglycerides, according to the study of registry data from the Netherlands.
The retrospective study involved nearly 2.8 million male veterans 65 to 99 years of age, 32.3% with diabetes, who received primary care at Veterans Health Administration medical centers from 2000 to 2010.
From 2000 to 2014, the age-standardized incidence of end-stage renal disease (ESRD) attributed to diabetes decreased from 260.2 to 173.9 per 100,000 diabetic population.
The results provide further evidence that insulin pump therapy is safe and effective, even in routine diabetes care for unselected patients, according to the study authors.
A limitation of the industry-funded randomized trial was the high rate of early discontinuation: 43.0% of patients on exenatide and 45.2% of those on placebo.