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lüll Efficacy of intensive multitherapy for patients with type 2 diabetes mellitus: a randomized controlled trial Menard J; Payette H; Baillargeon JP; Maheux P; Lepage S; Tessier D; Ardilouze JLCMAJ 2005[Dec]; 173 (12): 1457-66BACKGROUND: National guidelines for managing diabetes set standards for care. We sought to determine whether a 1-year intensive multitherapy program resulted in greater goal attainment than usual care among patients with poorly controlled type 2 diabetes mellitus. METHODS: We identified patients with poorly controlled type 2 diabetes receiving outpatient care in the community or at our hospital. Patients 30-70 years of age with a hemoglobin A1c concentration of 8% or greater were randomly assigned to receive intensive multitherapy (n = 36) or usual care (n = 36). RESULTS: The average hemoglobin A1c concentration at entry was 9.1% (standard deviation [SD] 1%) in the intensive therapy group and 9.3% (SD 1%) in the usual therapy group. By 12 months, a higher proportion of patients in the intensive therapy group than in the control group had achieved Canadian Diabetes Association (CDA) goals for hemoglobin A(1c) concentrations (goal < or = 7.0%: 35% v. 8%), diastolic blood pressure (goal < 80 mm Hg: 64% v. 37%), low-density lipoprotein cholesterol (LDL-C) levels (goal < 2.5 mmol/L: 53% v. 20%) and triglyceride levels (goal < 1.5 mmol/L: 44% v. 14%). There were no significant differences between the 2 groups in attaining the targets for fasting plasma glucose levels, systolic blood pressure or total cholesterol:high-density lipoprotein cholesterol ratio. None of the patients reached all CDA treatment goals. By 18 months, differences in goal attainment were no longer evident between the 2 groups, except for LDL-C levels. Quality of life, as measured by a specific questionnaire, increased in both groups, with a greater increase in the intensive therapy group (13% [SD 10%] v. 6% [SD 13%], p < 0.003). INTERPRETATION: Intensive multitherapy for patients with poorly controlled type 2 diabetes is successful in helping patients meet most of the goals set by a national diabetes association. However, 6 months after intensive therapy stopped and patients returned to usual care, the benefits had vanished.|*Exercise[MESH]|Adult[MESH]|Aged[MESH]|Blood Glucose[MESH]|Blood Pressure[MESH]|Cholesterol, LDL/blood[MESH]|Diabetes Mellitus, Type 2/blood/complications/diet therapy/*therapy[MESH]|Dyslipidemias/complications/drug therapy[MESH]|Energy Intake[MESH]|Female[MESH]|Follow-Up Studies[MESH]|Glyburide/therapeutic use[MESH]|Glycated Hemoglobin[MESH]|Humans[MESH]|Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use[MESH]|Hypertension/complications[MESH]|Hypoglycemic Agents/*therapeutic use[MESH]|Insulin/therapeutic use[MESH]|Male[MESH]|Middle Aged[MESH]|Patient Education as Topic[MESH]|Quality of Life[MESH]|Triglycerides/blood[MESH] |