The Steno 2 trial was designed to show the difference between usual care—the care that most people receive— and optimal medical therapy (OMT). OMT is a protocol driven approach that combines diet, exercise, and medications that have been shown to reduce diabetes complications more than they reduce the target risk factor. When the trial started, none of the individuals in the trial had congestive heart failure. The trial was not designed to prevent or treat congestive heart failure, but analysis of trial data at 21 years of follow-up shows OMT is the most powerful intervention known to prevent hospitalization for heart failure. Compared with usual care, OMT reduced hospitalizations for heart failure by 70%. That is extremely important because we all have a stake in reducing heart failure hospitalizations.
That is because heart failure is so dangerous and expensive. Heart failure is a serious complication in type 2 diabetes, with an average survival from diagnosis of 3.5 years, and a 5-year mortality rate of 75% The health prospects of individuals with type 2 diabetes and heart failure is worse than that of heart failure patients without diabetes.
Most heart failure hospitalizations occur in patients over the age of 65 and so we all pay for those hospitalizations through our taxes. Patients with a heart failure diagnosis account for fully one third of all Medicare spending and most of that is related to hospitalizations. Just think of the potential savings generated by reducing heart failure admissions by 70%. These reductions were seen without regard for the type of heart failure that caused the hospitalization. Heart failure patients also account for 55% of all Medicare readmissions, which is another big problem. The patients in this trial were 55 years old and already had chronic kidney disease.
Figure 2 on page 1729 of the first link is very difficult to replicate. It shows that the first hospitalization for heart failure did not occur until nearly two years into the study. Eight years in, only about 3% of OMT patients had been hospitalized for heart failure compared to 20% in the usual care group. As I explained in the last post, everyone went on OMT at this point in the study because the proven benefits were so great. It was unethical to leave patients in usual care. Again, since everyone was on OMT you would expect the heart failure hospitalization curves to come closer together, but that did not happen. At 21 years of follow-up, only 15% of OMT patients had been hospitalized for heart failure compared to 42% in usual care. There is no other treatment for congestive heart failure that comes close to that result.
This difference in result between OMT and usual care once again shows that early aggressive care provides much greater benefit even when both groups later are on OMT. These differences are due to changes in gene regulation that persist even after treatments are the same. After just eight years, when it became apparent that OMT for diabetes is vastly superior to the care most people are receiving, the researchers decided to put everyone on OMT. They said it would be unethical to continue to treat patients with usual care. After twenty-one years of follow-up, we know that hospitalizations for heart failure are reduced by 70%, OMT patients live 8 years longer and their heart attacks and strokes are delayed by eight years. We have also learned that patients with a delayed start of OMT never get the protection afforded by beginning OMT eight years earlier. When will decide that failing to provide OMT is unethical for our patients in the community? We know more about OMT today and it is even more effective. Every American with type 2 diabetes should have access to optimal medical therapy. It is time to get started.
Except that in NY City the programs for reversing diabetes with lifestyle medicine at city hospitals have been oversubscribed for as long as they've existed, and not because it doesn't work, but because it does. And I know many of the doctors involved, and I am also familiar with hundreds of cases. https://www.nychealthandhospitals.org/services/plant-based-lifestyle-medicine-program/
Could you define Optimum medical treatment with more detail