Intensive Diabetes Treatment and Cardiovascular Outcomes in Type 1 Diabetes: The DCCT/EDIC Study 30-Year Follow-up
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Open Access
- 9 February 2016
- journal article
- research article
- Published by American Diabetes Association in Diabetes Care
- Vol. 39 (5), 686-693
- https://doi.org/10.2337/dc15-1990
Abstract
OBJECTIVE: Early initiation of intensive diabetes therapy aimed at achieving near-normal glycemia reduces the early development of vascular complications in type 1 diabetes. We now assess whether intensive therapy compared with conventional therapy during the Diabetes Control and Complications Trial (DCCT) affected the incidence of cardiovascular disease over 30 years of follow-up. RESEARCH DESIGN AND METHODS: The DCCT randomly assigned 1,441 patients with type 1 diabetes to intensive versus conventional therapy for a mean of 6.5 years, after which 93% were subsequently monitored during the observational Epidemiology of Diabetes Interventions and Complications (EDIC) study. Cardiovascular disease (nonfatal myocardial infarction and stroke, cardiovascular death, confirmed angina, congestive heart failure, and coronary artery revascularization) was adjudicated using standardized measures. RESULTS: During 30 years of follow-up in DCCT and EDIC, 149 cardiovascular disease events occurred in 82 former intensive treatment group subjects versus 217 events in 102 former conventional treatment group subjects. Intensive therapy reduced the incidence of any cardiovascular disease by 30% (95% CI 7, 48; P = 0.016), and the incidence of major cardiovascular events (nonfatal myocardial infarction, stroke, or cardiovascular death) by 32% (95% CI −3, 56; P = 0.07). The lower HbA1c levels during the DCCT/EDIC statistically account for all of the observed treatment effect on cardiovascular disease risk. Increased albuminuria was also independently associated with cardiovascular disease risk. CONCLUSIONS: Intensive diabetes therapy during the DCCT (6.5 years) has long-term beneficial effects on the incidence of cardiovascular disease in type 1 diabetes that persist for up to 30 years.Keywords
Funding Information
- National Institute of Diabetes and Digestive and Kidney Disease
This publication has 34 references indexed in Scilit:
- Is glycaemia or insulin dose the stronger risk factor for coronary artery disease in type 1 diabetes?Diabetes and Vascular Disease Research, 2009
- 10-Year Follow-up of Intensive Glucose Control in Type 2 DiabetesThe New England Journal of Medicine, 2008
- Risk Factors Related to Inflammation and Endothelial Dysfunction in the DCCT/EDIC Cohort and Their Relationship With Nephropathy and Macrovascular ComplicationsDiabetes Care, 2008
- Insulin Therapy, Hyperglycemia, and Hypertension in Type 1 Diabetes MellitusJAMA Internal Medicine, 2008
- Intensive Blood Glucose Control and Vascular Outcomes in Patients with Type 2 DiabetesThe New England Journal of Medicine, 2008
- Effects of Intensive Glucose Lowering in Type 2 DiabetesThe New England Journal of Medicine, 2008
- Relationship of Glycemic Control, Exogenous Insulin, and C-Peptide Levels to Ischemic Heart Disease Mortality Over a 16-Year Period in People With Older-Onset DiabetesDiabetes Care, 2008
- Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)The Lancet, 1998
- Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34)The Lancet, 1998
- Effect of intensive diabetes management on macrovascular events and risk factors in the diabetes control and complications trialThe American Journal of Cardiology, 1995