June 8, 2009

(USA TODAY) -- Prompt bypass surgery holds no advantage over intensive drug therapy in many patients with type 2 diabetes when it comes to dying from strokes or heart attacks, new research suggests.

Results from a study that explored the best treatment for patients with both type 2 diabetes and stable coronary heart disease were reported Sunday at the American Diabetes Association's 69th scientific conference in New Orleans. The study, a multicenter trial led by the University of Pittsburgh Graduate School of Public Health, took place at 49 medical centers in six countries over five years.

"It's the first time any randomized clinical trial has shown a reduction in non-fatal heart attack rates in stable patients with diabetes and heart disease," says cardiologist Robert Frye, a professor of medicine at the Mayo Clinic and a study chairman.

The study evaluated two surgery approaches as well as a drug-focused approach in 2,368 people with type 2 diabetes and stable coronary artery disease to help determine the best way to reduce deaths and cardiovascular events (heart attacks and stroke).

Intensive medical, or drug-based, treatment combined with either prompt bypass surgery or angioplasty (balloons through the arteries) was compared with intensive medical treatment alone.

Survival rates were 88% overall, says Montefiore Medical Center investigator Joel Zonszein.

"A 12% mortality rate at five years in this population is wonderful. It shows they do very well when treated well with medication." Cardiovascular-related mortality rates for diabetics are typically in the range of about 22% to 28%, he says.

Among participants pre-identified for coronary bypass surgery, the group who received prompt surgery had significantly fewer heart attacks or strokes vs. those who received medical therapy only, Frye says.

"The study reinforces that for people with diabetes and mild heart disease, medical therapy works, and works very well," Zonzsein says.

Adherence to a medication plan is key to heart health, says Richard Kahn, chief scientific and medical officer of the ADA. "Faithfully taking meds and keeping blood glucose under control works and is certainly less expensive, less intrusive and less painful than surgical intervention."

In other conference news:

--An expert committe has recommended the A1C blood test, long used to monitor glucose levels, as a diagnostic tool.

--A new study suggests the controversial drug rosiglitazone, or Avandia, may be safer on the heart in some patients than previously suggested, but many experts say they remain wary.