Multifactorial Intervention in Type 2 Diabetes

  • Oluf Pedersen

Keywords: Diabetes, cardiovascular disorder, microangiopathy, macroangiopathy, risk factors, health behaviour, polypharmacy, drug concordance, patient, motivation, patient education.


Absolute Risk Reduction Diabetes Educator Multifactorial Intervention Conventional Therapy Group Intensive Therapy Group 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Fabre J, Balant LP, Dayer PG, Fox HM, Vernet AT. The kidney in maturity onset diabetes mellitus: a clinical study of 510 patients. Kidney Int 1982;21:730–738.CrossRefPubMedGoogle Scholar
  2. 2.
    Wingard DL, Barrett-Connor EL. Heart disease and diabetes. In: Harris MI, Cowie CC, Stern MS, Boyko EJ, Rieber GE, Bennet PH (eds.), Diabetes in America, 2nd ed. Washington: National Institutes of Health: 1995;429–448.Google Scholar
  3. 3.
    Laakso M, Lehto S. Epidemiology of macrovascular disease in diabetes. Diabet Rev 1997;5:294–315.Google Scholar
  4. 4.
    Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998;339:229–234.CrossRefPubMedGoogle Scholar
  5. 5.
    Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care 1993;16: 434–444.CrossRefPubMedGoogle Scholar
  6. 6.
    Turner RC, Millns H, Neil HA, Stratton IM, Manley SE, Matthews DR, Holman RR. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS: 23). BMJ 1998;316:823–828.PubMedGoogle Scholar
  7. 7.
    Standl E, Balletshofer B, Dahl B, Weichenhain B, Stiegler H, Hormann A, Holle R. Predictors of 10-year macrovascular and overall mortality in patients with NIDDM: the Munich General Practitioner Project. Diabetologia 1996;39:1540–1545.CrossRefPubMedGoogle Scholar
  8. 8.
    Sowers J, Stump C. Insights into the biology of diabetic vascular disease: what's new? Am J Hypertens 2004;17:2–6.CrossRefGoogle Scholar
  9. 9.
    Forman D, Bulwer BE. Cardiovascular disease: optimal approaches to risk factor modification of diet and lifestyle. Curr Treat Opt Cardiovasc Med 2006; 8:47–57.CrossRefGoogle Scholar
  10. 10.
  11. 11.
    Hovens MM, Tamsma JT, Beishuizen ED, Huisman MV. Pharmacological strategies to reduce cardiovascular risk in type 2 diabetes mellitus: an update. Drugs 2005;65:433–445.CrossRefPubMedGoogle Scholar
  12. 12.
    Gæde P, Pedersen O. Target intervention against multiple risk markers to reduce cardiovascular disease in patients with type 2 diabetes. Ann Med 2004;36: 355–366.CrossRefPubMedGoogle Scholar
  13. 13.
    Gæde P, Pedersen O. Intensive integrated therapy of type 2 diabetes: implications for long-term prognosis. Diabetes 2004;53:S39–S47.CrossRefPubMedGoogle Scholar
  14. 14.
    Gæde P, Pedersen O: Multi-targeted and aggressive treatment of patients with type 2 diabetes at high risk: what are we waiting for? Horm Metab Res 2005;37 (Suppl 1):76–82.CrossRefPubMedGoogle Scholar
  15. 15.
    American Diabetes Association. Standards of Medical Care in Diabetes–2006. Diabetes Care 2006;29:S4–S42.Google Scholar
  16. 16.
    Gæde 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;348:383–393.CrossRefPubMedGoogle Scholar
  17. 17.
    Gæde 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;353:617–622.CrossRefPubMedGoogle Scholar
  18. 18.
    Lauritzen T, Griffin S, Borch-Johnsen K, Wareham NJ, Wolffenbuttel BH, Rutten G, Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen Detected Diabetes in Primary Care. The ADDITION study: proposed trial of the cost-effectiveness of an intensive multifactorial intervention on morbidity and mortality among people with type 2 diabetes detected by screening. Int J Obes 2000;24 (Suppl 3):S6–S11.CrossRefGoogle Scholar
  19. 19.
    Eliasson B, Cederholm J, Nilsson P, Gudbjornsdottir S, Steering Committee of the Swedish National Diabetes Register. The gap between guidelines and reality: type 2 diabetes in a National Diabetes Register 1996–2003. Diabet Med 2005;10:1420–1426.CrossRefGoogle Scholar
  20. 20.
    Saydah SH, Fradkin J, Cowie CC. Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes. JAMA 2004;291: 335–342.CrossRefPubMedGoogle Scholar
  21. 21.
    Griffin S, Kinmonth AL. Systems for routine surveillance for people with diabetes mellitus (Cochrane Review). In The Cochrane Library. Oxford: Update Software: 2002.Google Scholar
  22. 22.
    Olivarius NF, Beck-Nielsen H, Andreasen AH, Horder M, Pedersen PA. Randomised controlled trial of structured personal care of type 2 diabetes mellitus. BMJ 2001;323:970–975.CrossRefPubMedGoogle Scholar
  23. 23.
    Woodward A, Wallymahmed M, Wilding J, Gill G. Successful cardiovascular risk reduction in type 2 diabetes by nurse-led care using an open clinical algorithm. Diabet Med 2006;23:780–787.CrossRefPubMedGoogle Scholar
  24. 24.
    Rachmani R, Slavachevski I, Berla M, Frommer-Shapira R, Ravid M. Teaching and motivating patients to control their risk factors retards progression of cardiovascular as well as microvascular sequelae of type 2 diabetes mellitus – a randomized prospective 8 years follow-up study. Diabet Med 2005;22:410–414.CrossRefPubMedGoogle Scholar
  25. 25.
    Menard J, Payette H, Baillargeon JP, Maheux P, Lepage S, Tessier D, Ardilouze JL. Efficacy of intensive multitherapy for patients with type 2 diabetes mellitus: a randomized controlled trial. CMAJ 2005; 173:1457–1466.PubMedGoogle Scholar
  26. 26.
    Mateo JF, Gil-Guillen VF, Mateo E, Orozco D, Carbayo JA, Merino J. Multifactorial approach and adherence to prescribed oral medications in patients with type 2 diabetes. Int J Clin Pract 2006;60: 422–428.CrossRefPubMedGoogle Scholar
  27. 27.
    Glasgow RE, McCaul KD, Schafer LC. Barriers to regimen adherence among persons with insulin-dependent diabetes. J Behav Med 1986;9:65–77.CrossRefPubMedGoogle Scholar
  28. 28.
    Johansen J, Claudi T, Holtedahl K. Insulin treatment for poorly regulated diabetic patients in general practice. Better regulation and symptom relief? Scand J Prim Health Care 1999;17:244–249.CrossRefPubMedGoogle Scholar
  29. 29.
    Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%. BMJ 2003;326:1419.CrossRefPubMedGoogle Scholar
  30. 30.
    Snoek FJ. Barriers to good glycaemic control: the patient's perspective. Int J Obes 2000;24:S12–S20.CrossRefGoogle Scholar
  31. 31.
    Hiss RG. Barriers to care in non-insulin-dependent diabetes mellitus. The Michigan experience. Ann Intern Med 1996;124:146–148.PubMedGoogle Scholar
  32. 32.
    Kenny SJ, Smith PJ, Goldschmid MG, Newman JM, Herman WH. Survey of physician practice behaviors related to diabetes mellitus in the U.S. Physician adherence to consensus recommendations. Diabet Care 1993;16:1507–1510.CrossRefGoogle Scholar
  33. 33.
    Pan XR, Li GW, Hu YH, Wang JX, Yang WY, An ZX, Hu ZX, Lin J, Xiao JZ, Cao HB, Liu PA, Jiang XG, Jiang YY, Wang JP, Zeng H, Zhang H, Bennet PH, Howard BV. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care 1997;20:537–544.CrossRefPubMedGoogle Scholar
  34. 34.
    Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, Keinanen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa M. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001;344:1343–1350.CrossRefPubMedGoogle Scholar
  35. 35.
    Knowler WC, Barrett-Conor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM: Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346:393–403.CrossRefPubMedGoogle Scholar
  36. 36.
    DREAM (Diabetes Reduction Assessment with ramipril and rosiglitazone Medication) Trial Investigators, Gerstein HC, Yusuf S, Bosch J, Pogue J, Sheridan P, Dinccag N, Hanefeld M, Hoogwerf B, Laakso M, Mohan V, Shaw J, Zinman B, Holman RR. Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomised controlled trial. Lancet 2006;368:1096–1105.Google Scholar
  37. 37.
    UKPDS 16. Overview of 6 years' therapy of type II diabetes: a progressive disease. Diabetes 1995;44: 1249–1258.CrossRefGoogle Scholar
  38. 38.
    Poulsen MK, Henriksen JE, Hother-Nielsen O, Beck-Nielsen H. The combined effect of triple therapy with rosiglitazone, metformin, and insulin aspart in type 2 diabetic patients. Diabet Care 2003;26:3273–3279.CrossRefGoogle Scholar
  39. 39.
    Forrester JS, Shah PK. Emerging strategies for increasing high-density lipoprotein. Am. J. Cardiol 2006;98:1542–1549.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Oluf Pedersen
    • 1
  1. 1.Steno Diabetes CenterDenmark

Personalised recommendations