General Cardiology Perspective: Decision Making Regarding Revascularization of Patients With Type 2 Diabetes Mellitus and Cardiovascular Disease in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Trial

“Overall, the BARI 2D results reassure us that our current major drug treatments for diabetes are equally appropriate. They also indicate that when a patient with type 2 diabetes has more severe heart disease it may be better to do bypass surgery early than to wait and simply treat with medication. For patients with milder disease who are candidates for angioplasty, it is appropriate to treat with drug therapy first.”

Robert L. FryeProfessor of cardiovascular medicine, Mayo Clinic

“We observed that patients with more severe heart disease did better over time when they received bypass early compared to those who received drug therapy alone. Those who underwent bypass surgery seemed to do particularly well on insulin-sensitizing drugs. Although this result is preliminary because we did not set out to answer this question with our study design.”

“It's important to note that in a real-world setting, patients' blood sugar levels are not so closely monitored to maintain optimal levels as in this study. The patients I see with diabetes and heart disease frequently have difficulty complying with a drug regimen that includes upwards of 10 pills per day, often coupled with insulin injection. Not surprisingly, noncompliance can quickly lead to deteriorating health and should be carefully considered for patients who may be candidates for revascularization.”