Background Cardiovascular disease causes severe morbidity andmortality in type 1 diabetes, although the specific risk factorsand whether chronic hyperglycemia has a role are unknown. Weexamined the progression of carotid intima–media thickness,a measure of atherosclerosis, in a population with type 1 diabetes.
Methods As part of the Epidemiology of Diabetes Interventionsand Complications (EDIC) study, the long-term follow-up of theDiabetes Control and Complications Trial (DCCT), 1229 patientswith type 1 diabetes underwent B-mode ultrasonography of theinternal and common carotid arteries in 1994–1996 andagain in 1998–2000. We assessed the intima–mediathickness in 611 subjects who had been randomly assigned toreceive conventional diabetes treatment during the DCCT andin 618 who had been assigned to receive intensive diabetes treatment.
Results At year 1 of the EDIC study, the carotid intima–mediathickness was similar to that in an age- and sex-matched nondiabeticpopulation. After six years, the intima–media thicknesswas significantly greater in the diabetic patients than in thecontrols. The mean progression of the intima–media thicknesswas significantly less in the group that had received intensivetherapy during the DCCT than in the group that had receivedconventional therapy (progression of the intima–mediathickness of the common carotid artery, 0.032 vs. 0.046 mm;P=0.01; and progression of the combined intima–media thicknessof the common and internal carotid arteries, –0.155 vs.0.007; P=0.02) after adjustment for other risk factors. Progressionof carotid intima–media thickness was associated withage, and the EDIC base-line systolic blood pressure, smoking,the ratio of low-density lipoprotein to high-density lipoproteincholesterol, and urinary albumin excretion rate and with themean glycosylated hemoglobin value during the mean duration(6.5 years) of the DCCT.
Conclusions Intensive therapy during the DCCT resulted in decreasedprogression of intima–media thickness six years afterthe end of the trial.
Source Information
The writing group of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Research Group (David M. Nathan, M.D., John Lachin, Sc.D., Patricia Cleary, M.S., Trevor Orchard, M.D., David J. Brillon, M.D., Jye-Yu Backlund, M.P.H., Daniel H. O'Leary, M.D., and Saul Genuth, M.D.) assumes responsibility for the contents of this article.
Address reprint requests to DCCT/EDIC Research Group at Box NDIC/DCCT, Bethesda, MD 20892, or at dnathan{at}partners.org.
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