Intensified Multifactorial Intervention in Patients With Type 2 Diabetes and Microalbuminuria

NCT ID: NCT00320008

Last Updated: 2019-04-04

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ACTIVE_NOT_RECRUITING

Clinical Phase

NA

Total Enrollment

160 participants

Study Classification

INTERVENTIONAL

Study Start Date

1992-01-31

Study Completion Date

2025-12-31

Brief Summary

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The purpose of this study is to determine whether intensified multifactorial intervention comprising both behaviour modification and polypharmacy can reduce the risk for late diabetic complications compared to standard treatment in patients with type 2 diabetes and microalbuminuria.

Detailed Description

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The overall description of the Steno-2 Study is stated in four protocols approved by the regulatory authorities in Denmark. The protocol identification numbers are KA 92071gm (4 years intervention ), KA-99035g (8 years intervention ), KA-99035-GS (13 years follow-up since intervention start) and H-KA-99035-GS (21 year follow-up since intervention start).

The aim of the study was to determine whether intensified multifactorial intervention comprising both behaviour modification and polypharmacy can reduce the risk for late diabetic complications compared to standard treatment in patients with type 2 diabetes and microalbuminuria. The primary end point after four years of intervention was to progression to diabetic nephropathy with other microvascular complications as secondary end points. The primary end point after eight years of intervention was a composite CVD endpoint with microvascular complications as secondary end points.

The interventional part of the study was ended in December 2001 after a total of eight years of intervention. From that time on, all patients were followed in a post-trial study. Also, during post-trial period all patients in both original treatment arms received similar treatment resembling the treatment given in the original intensive arm of the study. The aim of the post-trial follow-up was to investigate the effect of intensified multifactorial intervention on i) mortality and ii) years of life gained, respectively, with such an interventional approach.

Endpoints in the two parts of the post-trial follow-up:

Part one at 13 years since start of intervention:

Primary endpoint: Total mortality. Secondary endpoints: Cardiovascular endpoints as defined previously; Microvascular disease.

Part two at 21 years since start of intervention:

Primary endpoint: Difference in median time to 50% mortality in each of the two original treatment groups Secondary endpoints: Cardiovascular endpoints as defined previously; Recurrent cardiovascular events; Microvascular disease.

Conditions

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Type 2 Diabetes

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Standard Treatment Arm

This arm will at any time during the active intervention period follow treatment guidelines by the Danish Medical Association for the treatment of type 2 diabetes.

Group Type ACTIVE_COMPARATOR

Diet

Intervention Type BEHAVIORAL

Exercise

Intervention Type BEHAVIORAL

Stop smoking

Intervention Type BEHAVIORAL

Glucose lowering therapy

Intervention Type DRUG

Blood pressure lowering therapy

Intervention Type DRUG

Lipid lowering therapy

Intervention Type DRUG

Intensive Treatment Arm

This arm will during the active intervention period be treated according to intensified multiple risk factor intervention following strict guidelines set out by the study protocol.

Group Type EXPERIMENTAL

Diet

Intervention Type BEHAVIORAL

Exercise

Intervention Type BEHAVIORAL

Stop smoking

Intervention Type BEHAVIORAL

Glucose lowering therapy

Intervention Type DRUG

Blood pressure lowering therapy

Intervention Type DRUG

Lipid lowering therapy

Intervention Type DRUG

Interventions

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Diet

Intervention Type BEHAVIORAL

Exercise

Intervention Type BEHAVIORAL

Stop smoking

Intervention Type BEHAVIORAL

Glucose lowering therapy

Intervention Type DRUG

Blood pressure lowering therapy

Intervention Type DRUG

Lipid lowering therapy

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Type 2 diabetes
* Microalbuminuria

Exclusion Criteria

* Stimulated serum C-peptide concentration less than 600 pmol/L
* Pancreatic insufficiency or diabetes secondary to pancreatitis
* Alcohol abuse
* Non-diabetic kidney disease
* Life-threatening disease with death probable within 4 years of study start
Minimum Eligible Age

40 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Peter Gæde

OTHER

Sponsor Role lead

Responsible Party

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Peter Gæde

Associate Professor

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Peter Gaede, Professor

Role: STUDY_DIRECTOR

Slagelse Hospital

Locations

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Slagelse Hospital

Slagelse, , Denmark

Site Status

Countries

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Denmark

References

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Gaede P, Vedel P, Parving HH, Pedersen O. Intensified multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: the Steno type 2 randomised study. Lancet. 1999 Feb 20;353(9153):617-22. doi: 10.1016/S0140-6736(98)07368-1.

Reference Type RESULT
PMID: 10030326 (View on PubMed)

Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003 Jan 30;348(5):383-93. doi: 10.1056/NEJMoa021778.

Reference Type RESULT
PMID: 12556541 (View on PubMed)

Gaede P, Lund-Andersen H, Parving HH, Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med. 2008 Feb 7;358(6):580-91. doi: 10.1056/NEJMoa0706245.

Reference Type RESULT
PMID: 18256393 (View on PubMed)

Gaede J, Oellgaard J, Ibsen R, Gaede P, Nortoft E, Parving HH, Kjellberg J, Pedersen O. A cost analysis of intensified vs conventional multifactorial therapy in individuals with type 2 diabetes: a post hoc analysis of the Steno-2 study. Diabetologia. 2019 Jan;62(1):147-155. doi: 10.1007/s00125-018-4739-3. Epub 2018 Oct 6.

Reference Type RESULT
PMID: 30293113 (View on PubMed)

Oellgaard J, Gaede P, Persson F, Rossing P, Parving HH, Pedersen O. Application of urinary proteomics as possible risk predictor of renal and cardiovascular complications in patients with type 2-diabetes and microalbuminuria. J Diabetes Complications. 2018 Dec;32(12):1133-1140. doi: 10.1016/j.jdiacomp.2018.09.012. Epub 2018 Sep 24.

Reference Type RESULT
PMID: 30282584 (View on PubMed)

Kjaer LK, Oellgaard J, Henriksen T, Gaede P, Pedersen O, Poulsen HE. Indicator of RNA oxidation in urine for the prediction of mortality in patients with type 2 diabetes and microalbuminuria: A post-hoc analysis of the Steno-2 trial. Free Radic Biol Med. 2018 Dec;129:247-255. doi: 10.1016/j.freeradbiomed.2018.09.030. Epub 2018 Sep 21.

Reference Type RESULT
PMID: 30244028 (View on PubMed)

Oellgaard J, Gaede P, Rossing P, Persson F, Parving HH, Pedersen O. Intensified multifactorial intervention in type 2 diabetics with microalbuminuria leads to long-term renal benefits. Kidney Int. 2017 Apr;91(4):982-988. doi: 10.1016/j.kint.2016.11.023. Epub 2017 Feb 7.

Reference Type RESULT
PMID: 28187983 (View on PubMed)

Oellgaard J, Gaede P, Rossing P, Rorth R, Kober L, Parving HH, Pedersen O. Reduced risk of heart failure with intensified multifactorial intervention in individuals with type 2 diabetes and microalbuminuria: 21 years of follow-up in the randomised Steno-2 study. Diabetologia. 2018 Aug;61(8):1724-1733. doi: 10.1007/s00125-018-4642-y. Epub 2018 May 30.

Reference Type RESULT
PMID: 29850922 (View on PubMed)

Gaede P, Oellgaard J, Carstensen B, Rossing P, Lund-Andersen H, Parving HH, Pedersen O. Years of life gained by multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: 21 years follow-up on the Steno-2 randomised trial. Diabetologia. 2016 Nov;59(11):2298-2307. doi: 10.1007/s00125-016-4065-6. Epub 2016 Aug 16.

Reference Type RESULT
PMID: 27531506 (View on PubMed)

Cashmore BA, Cooper TE, Evangelidis NM, Green SC, Lopez-Vargas P, Tunnicliffe DJ. Education programmes for people with chronic kidney disease and diabetes. Cochrane Database Syst Rev. 2024 Aug 22;8(8):CD007374. doi: 10.1002/14651858.CD007374.pub3.

Reference Type DERIVED
PMID: 39171639 (View on PubMed)

Do DV, Han G, Abariga SA, Sleilati G, Vedula SS, Hawkins BS. Blood pressure control for diabetic retinopathy. Cochrane Database Syst Rev. 2023 Mar 28;3(3):CD006127. doi: 10.1002/14651858.CD006127.pub3.

Reference Type DERIVED
PMID: 36975019 (View on PubMed)

Natale P, Palmer SC, Saglimbene VM, Ruospo M, Razavian M, Craig JC, Jardine MJ, Webster AC, Strippoli GF. Antiplatelet agents for chronic kidney disease. Cochrane Database Syst Rev. 2022 Feb 28;2(2):CD008834. doi: 10.1002/14651858.CD008834.pub4.

Reference Type DERIVED
PMID: 35224730 (View on PubMed)

Gaede P, Oellgaard J, Kruuse C, Rossing P, Parving HH, Pedersen O. Beneficial impact of intensified multifactorial intervention on risk of stroke: outcome of 21 years of follow-up in the randomised Steno-2 Study. Diabetologia. 2019 Sep;62(9):1575-1580. doi: 10.1007/s00125-019-4920-3. Epub 2019 Jun 1.

Reference Type DERIVED
PMID: 31154479 (View on PubMed)

Gaede P, Valentine WJ, Palmer AJ, Tucker DM, Lammert M, Parving HH, Pedersen O. Cost-effectiveness of intensified versus conventional multifactorial intervention in type 2 diabetes: results and projections from the Steno-2 study. Diabetes Care. 2008 Aug;31(8):1510-5. doi: 10.2337/dc07-2452. Epub 2008 Apr 28.

Reference Type DERIVED
PMID: 18443195 (View on PubMed)

Other Identifiers

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KA92071gm

Identifier Type: -

Identifier Source: org_study_id

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