Rationale, design, and methods for glycemic control in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Trial

Am J Cardiol. 2006 Jun 19;97(12A):20G-30G. doi: 10.1016/j.amjcard.2006.02.024. Epub 2006 Apr 19.

Abstract

A major therapeutic question in considering accelerated atherogenesis in patients with type 2 diabetes mellitus is whether reducing insulin resistance, as a proximal defect of a host of proatherogenic abnormalities including hyperglycemia, will be superior for decreasing mortality and coronary artery disease (CAD) risk compared with treating hyperglycemia to overcome insulin resistance with insulin-providing agents. This question is highly relevant, since earlier targeted glycemic control trials utilizing conventional glucose-lowering strategies that increase insulin levels have generally failed to reduce CAD risk despite markedly reducing microvascular risk. The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial seeks to determine whether primarily using an insulin-sensitizing strategy for treatment of type 2 diabetes is superior when compared with primarily using an insulin-providing strategy with regard to cardiovascular outcomes. This article presents the rationale, design, and methods being used to test the glycemic control hypothesis in BARI 2D.

MeSH terms

  • Algorithms
  • Angioplasty, Balloon, Coronary
  • Coronary Artery Bypass
  • Coronary Artery Disease / blood
  • Coronary Artery Disease / complications
  • Coronary Artery Disease / therapy*
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / complications
  • Diabetes Mellitus, Type 1 / therapy*
  • Humans
  • Hyperglycemia / blood
  • Hyperglycemia / complications
  • Hyperglycemia / therapy
  • Hypoglycemic Agents / therapeutic use
  • Myocardial Revascularization
  • Randomized Controlled Trials as Topic*
  • Research Design

Substances

  • Hypoglycemic Agents