Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes

David M. Nathan, Patricia A. Cleary, Jye Yu C Backlund, Saul M. Genuth, John M. Lachin, Trevor J. Orchard, Philip Raskin, Bernard Zinman

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Intensive diabetes therapy aimed at achieving near normoglycemia reduces the risk of microvascular and neurologic complications of type 1 diabetes. We studied whether the use of intensive therapy as compared with conventional therapy during the Diabetes Control and Complications Trial (DCCT) affected the long-term incidence of cardiovascular disease. METHODS: The DCCT randomly assigned 1441 patients with type 1 diabetes to intensive or conventional therapy, treating them for a mean of 6.5 years between 1983 and 1993. Ninety-three percent were subsequently followed until February 1, 2005, during the observational Epidemiology of Diabetes Interventions and Complications study. Cardiovascular disease (defined as nonfatal myocardial infarction, stroke, death from cardiovascular disease, confirmed angina, or the need for coronary-artery revascularization) was assessed with standardized measures and classified by an independent committee. RESULTS: During the mean 17 years of follow-up, 46 cardiovascular disease events occurred in 31 patients who had received intensive treatment in the DCCT, as compared with 98 events in 52 patients who had received conventional treatment. Intensive treatment reduced the risk of any cardiovascular disease event by 42 percent (95 percent confidence interval, 9 to 63 percent; P=0.02) and the risk of nonfatal myocardial infarction, stroke, or death from cardiovascular disease by 57 percent (95 percent confidence interval, 12 to 79 percent; P=0.02). The decrease in glycosylated hemoglobin values during the DCCT was significantly associated with most of the positive effects of intensive treatment on the risk of cardiovascular disease. Microalbuminuria and albuminuria were associated with a significant increase in the risk of cardiovascular disease, but differences between treatment groups remained significant (P≤0.05) after adjusting for these factors. CONCLUSIONS: Intensive diabetes therapy has long-term beneficial effects on the risk of cardiovascular disease in patients with type 1 diabetes.

Original languageEnglish (US)
Pages (from-to)2643-2653
Number of pages11
JournalNew England Journal of Medicine
Volume353
Issue number25
DOIs
StatePublished - Dec 22 2005

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Type 1 Diabetes Mellitus
Cardiovascular Diseases
Diabetes Complications
Therapeutics
Stroke
Myocardial Infarction
Confidence Intervals
Albuminuria
Glycosylated Hemoglobin A
Nervous System
Coronary Vessels
Epidemiology
Incidence

ASJC Scopus subject areas

  • Medicine(all)

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Nathan, D. M., Cleary, P. A., Backlund, J. Y. C., Genuth, S. M., Lachin, J. M., Orchard, T. J., ... Zinman, B. (2005). Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. New England Journal of Medicine, 353(25), 2643-2653. https://doi.org/10.1056/NEJMoa052187

Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. / Nathan, David M.; Cleary, Patricia A.; Backlund, Jye Yu C; Genuth, Saul M.; Lachin, John M.; Orchard, Trevor J.; Raskin, Philip; Zinman, Bernard.

In: New England Journal of Medicine, Vol. 353, No. 25, 22.12.2005, p. 2643-2653.

Research output: Contribution to journalArticle

Nathan, DM, Cleary, PA, Backlund, JYC, Genuth, SM, Lachin, JM, Orchard, TJ, Raskin, P & Zinman, B 2005, 'Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes', New England Journal of Medicine, vol. 353, no. 25, pp. 2643-2653. https://doi.org/10.1056/NEJMoa052187
Nathan DM, Cleary PA, Backlund JYC, Genuth SM, Lachin JM, Orchard TJ et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. New England Journal of Medicine. 2005 Dec 22;353(25):2643-2653. https://doi.org/10.1056/NEJMoa052187
Nathan, David M. ; Cleary, Patricia A. ; Backlund, Jye Yu C ; Genuth, Saul M. ; Lachin, John M. ; Orchard, Trevor J. ; Raskin, Philip ; Zinman, Bernard. / Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. In: New England Journal of Medicine. 2005 ; Vol. 353, No. 25. pp. 2643-2653.
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