Background Intensive diabetes therapy aimed at achieving nearnormoglycemia reduces the risk of microvascular and neurologiccomplications of type 1 diabetes. We studied whether the useof intensive therapy as compared with conventional therapy duringthe Diabetes Control and Complications Trial (DCCT) affectedthe long-term incidence of cardiovascular disease.
Methods The DCCT randomly assigned 1441 patients with type 1diabetes to intensive or conventional therapy, treating themfor a mean of 6.5 years between 1983 and 1993. Ninety-threepercent were subsequently followed until February 1, 2005, duringthe observational Epidemiology of Diabetes Interventions andComplications study. Cardiovascular disease (defined as nonfatalmyocardial infarction, stroke, death from cardiovascular disease,confirmed angina, or the need for coronary-artery revascularization)was assessed with standardized measures and classified by anindependent committee.
Results During the mean 17 years of follow-up, 46 cardiovasculardisease events occurred in 31 patients who had received intensivetreatment in the DCCT, as compared with 98 events in 52 patientswho had received conventional treatment. Intensive treatmentreduced the risk of any cardiovascular disease event by 42 percent(95 percent confidence interval, 9 to 63 percent; P=0.02) andthe risk of nonfatal myocardial infarction, stroke, or deathfrom cardiovascular disease by 57 percent (95 percent confidenceinterval, 12 to 79 percent; P=0.02). The decrease in glycosylatedhemoglobin values during the DCCT was significantly associatedwith most of the positive effects of intensive treatment onthe risk of cardiovascular disease. Microalbuminuria and albuminuriawere associated with a significant increase in the risk of cardiovasculardisease, but differences between treatment groups remained significant(P0.05) after adjusting for these factors.
Conclusions Intensive diabetes therapy has long-term beneficialeffects on the risk of cardiovascular disease in patients withtype 1 diabetes.
Source Information
The Writing Committee David M. Nathan, M.D. (chair), Patricia A. Cleary, M.S., Jye-Yu C. Backlund, M.S., Saul M. Genuth, M.D., John M. Lachin, D.Sc., Trevor J. Orchard, M.D., Philip Raskin, M.D., and Bernard Zinman, M.D. vouches for the accuracy and integrity of the data.
Address reprint requests to the DCCT/EDIC Research Group at Box NDIC/DCCT, Bethesda, MD 20892, or at dnathan{at}partners.org.
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