BARI 2D TRIAL

• Patients with Type 2 diabetes have an increased risk of suffering a cardiovascular event over non-diabetic patients.
• The 5-year death rate for the group receiving insulin sensitization therapy was 13.2% vs. 13.5% in the group receiving insulin provision therapy.The difference between the two groups was not statistically significant.
• The rates of MI, stroke and the combined secondary endpoint of death, MI, and stroke were similar between the group receiving revascularization plus optimal medical therapy vs. the group receiving optimal medical therapy alone.
• The rates of MI, stroke and the combined secondary endpoint of death, MI, and stroke were similar between the group insulin sensitization therapy vs. the group receiving insulin provision therapy.

Limitations-
• Patients who are at high risk for MI and can be benefitted from revascularization were excluded from the trial.
• The broad applicability of BARI 2D is limited by the fact that the patient population selected represents only a small subset of patients with diabetes and coronary artery disease.

Summary-
• Neither revascularization nor optimal medical therapy demonstrated a significant reduction in the occurrence of death or major cardiovascular events at 5 years.
• There was no demonstrated difference between a strategy of insulin sensitization and insulin provision.
• Further research into defining optimal medical therapy for this group of patients is needed, as evidenced by the fact that 42.1% of patients in the optimal medical therapy alone treatment group eventually required revascularization within 5 years.

- by Dr Amarja