This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Type 2 diabetes mellitus is one of the strongest risk factors for coronary artery disease (CAD) and consequent mortality. The optimal treatment for this large group of patients is not yet known. Coronary revascularization, while increasingly used, has not been shown to be of increased benefit when used along with management of hyperglycemia, hypertension, dyslipidemia and other risk factors. Further, while intensive efforts to lower HbA1c have been demonstrated to favorably affect the clinical course of Type 2 diabetes mellitus in terms of microvascular complications, the optimal hyperglycemia management strategy with regard to macrovascular outcome is not known. The purpose of this study is to determine: 1) the efficacy of initial elective coronary revascularization combined with aggressive medical therapy, compared to an initial strategy of aggressive medical therapy alone; and 2) the efficacy of a strategy of providing more insulin (endogenous or exogenous) versus a strategy of increasing sensitivity to insulin (reducing insulin resistance) in the management of hyperglycemia, with a target HbA1c level of < 7.0% for each strategy.
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