The lack of effect of intensive glycemic control on the reduction of CVD events in individuals with type 2 diabetes of longer duration heightens the importance of other risk factors in the disease process and emphasizes the need for a multifactorial approach of treatment.
A multifactorial approach is needed for the management of risk factors (i.e. total cholesterol, hyperglycaemia and anaemia, as well as blood pressure) in patients with diabetes.
Previous studies targeting neuronal apoptosis by overexpressing intrinsic growth factors, inhibiting apoptosis and enhancing regeneration in CNS trauma models have established that a multifactorial approach is required for successful and long-lasting therapeutic outcomes.
Given that this multifactorial approach took ∼8 years for the difference to emerge, and the overall mortality rate at 3.5 years in the ACCORD trial was lower than seen in earlier studies of similar patients (22, 23), it is possible that the intensive arm was terminated prematurely with the benefit potentially emerging later.
Clinicians and researchers working in the field of headache disorders are becoming increasingly aware of the consequences of this condition, the resultant need for a multifactorial approach and treatment [25].
These findings in ADVANCE, UKPDS, and NDR jointly call for a multifactorial approach to improve HbA1c, blood pressure, and other risk factors.
Pain behaviours persist over time among individuals with CLBP, independent of pain severity and psychological factors, highlighting the difficulty in behaviour change and the need for a multifactorial approach [ 55].
The presence of other contributing factors would suggest the need for a more multifactorial approach to combat rising type 2 diabetes in the population.
The intensive therapy resulted in almost a 50% decrease in the risk of cardiovascular events providing evidence that a multifactorial approach is superior to conventional therapy for the prevention of oxidative stress-induced vascular complications in diabetes.
