Best treatment for diabetics with CAD

In this trial of 2368 diabetics with CAD, they randomized (in a 2X2 factorial fashion) to either revascularization (within 4 weeks) or medical treatment, and to either insulin provision therapy (insulin or sulfonylurea) or insulin sensitization therapy (metformin or thiazolidinedione). There were no significant differences between the groups in 5-year death / major cardiovascular events. However, those undergoing CABG (and not PCI) had lower CV events than those undergoing medical treatment (abstract). An editorialist summarizes the findings:For diabetics with CAD, initial medical therapy is reasonable, but if revascularization is warranted, CABG is the preferred choice for diabetics.

Danielle Scheurer

Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.

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