A randomized trial of therapies for type 2 diabetes and coronary artery disease.

TLDR: Overall, there was no significant difference in the rates of death and major cardiovascular events between patients undergoing prompt revascularization and those undergoing medical therapy or between strategies of insulin sensitization and insulin provision.

Abstract: At 5 years, rates of survival did not differ significantly between the revascularization group (88.3%) and the medical ­ therapy group (87.8%, P = 0.97) or between the in­ sulin ­ sensitization group (88.2%) and the insulin ­ provision group (87.9%, P = 0.89). The rates of freedom from major cardiovascular events also did not differ signifi­ cantly among the groups: 77.2% in the revascularization group and 75.9% in the medical ­ treatment group (P = 0.70) and 77.7% in the insulin ­ sensitization group and 75.4% in the insulin ­ provision group (P = 0.13). In the PCI stratum, there was no sig­ nificant difference in primary end points between the revascularization group and the medical ­ therapy group. In the CABG stratum, the rate of major cardiovascular events was significantly lower in the revascularization group (22.4%) than in the medical ­ therapy group (30.5%, P = 0.01; P = 0.002 for interaction between stratum and study group). Adverse events and serious adverse events were generally similar among the groups, although severe hypoglycemia was more frequent in the insulin ­ provision group (9.2%) than in the insulin ­ sensitization group (5.9%, P = 0.003). Conclusions Overall, there was no significant difference in the rates of death and major cardio­ vascular events between patients undergoing prompt revascularization and those undergoing medical therapy or between strategies of insulin sensitization and in­ sulin provision. (ClinicalTrials.gov number, NCT00006305.)