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-- Participants who were taught intensive therapy for type 1 diabetes during the Diabetes Control and Complications Trial (DCCT) experienced clinically beneficial effects on cardiovascular outcomes at 30 years of follow-up, according to research published online Feb. 9 in Diabetes Care.
The DCCT/Epidemiology of Diabetes Interventions and Complications (EDIC) Study Research Group assessed whether intensive therapy compared with conventional therapy during the DCCT (mean, 6.5 years) had an effect on the incidence of cardiovascular disease (CVD) over 30 years of follow-up.
The researchers found that at 30 years of follow-up in the DCCT and EDIC, 149 CVD events had occurred in 82 former participants from the intensive treatment group versus 217 CVD events in 102 of those from the conventional treatment group.
For those in the intensive therapy group, the incidence of any cardiovascular disease was reduced by 30 percent (95 percent confidence interval, 7 to 48 percent; P = 0.016), and the incidence of major cardiovascular events (nonfatal myocardial infarction, stroke, or cardiovascular death) was reduced by 32 percent (95 percent confidence interval, −3 to 56 percent; P = 0.07).
"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," the authors write.
Abstract
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Intensive Diabetes Treatment and Cardiovascular Outcomes in Type 1 Diabetes: The DCCT/EDIC Study 30-Year Follow-up
- The Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Study Research Group⇑*
- Corresponding author: Rose Gubitosi-Klug, Den här e-postadressen skyddas mot spambots. Du måste tillåta JavaScript för att se den..
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 HbA1clevels 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.