Effect of intensive diabetes management on macrovascular events and risk factors in the diabetes control and complications trial

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The Diabetes Control and Complications Trial (DCCT), a multicenter, randomized, controlled clinical trial, demonstrated that intensive diabetes therapy delays the onset and slows the progression of retinopathy, nephropathy, and neuropathy in patients with insulin-dependent diabetes mellitus. This study presents the affect of intensive therapy on atherosclerosis-related events and associated risk factors. Patients (n = 1,441) between the ages of 13 and 39 years with insulindependent diabetes mellitus were randomly assigned to conventional or intensive diabetes treatment. The patients were free of cardiovascular disease at baseline. Patients with hypertension, hypercholesterolemia, or obesity were excluded. Average length of follow-up was 6.5 years (range 3.5 to 9). The study used standardized definitions of macrovascular events, verification of such events, and central laboratories for determination of lipids and the grading of electrocardiograms. The number of combined major macrovascular events was almost twice as high in the conventionally treated group (40 events) as in the intensive-treatment group (23 events), although the differences were not statistically significant (p = 0.08). There were no differences in the cumulative incidence of hypertension. Mean total serum cholesterol, calculated low-density lipoprotein cholesterol, and triglycerides were significantly reduced in the intensive-treatment group (p ≤ 0.01), as was the development of low-density lipoprotein cholesterol levels >160 mg/dl. Weight gain was significanlty increased in the intensive-treatment group (p < 0.001). There were no differences in cigarette smoking habits, consumption of alcohol, or aspirin use between treatment groups. The reduction in some, but not all, cardiovascular risk factors suggests a potential beneficial effect of intensive therapy on macrovascular disease in insulin-dependent diabetes mellitus.

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      Citation Excerpt :

      Greater HbA1c variability has been associated with increased mortality and earlier hospital admission rates in patients with type-1 DM [32]. Furthermore, long-term insulin therapy has been linked to higher body weight and consequently elevated blood pressure [29,33,34], both of which are serious concerns in this patient group since it may interfere with treatment adherence [35] and can lead to increased mortality [36]. It has also been shown that optimal glycemic control is often underachieved internationally despite improvements in patient education, DM awareness, and improved insulin delivery systems [37–40].

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    This study was supported in part by the Division of Diabetes, Endocrinology and Metabolic Diseases of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, through cooperative agreements and a research contract, and by the National Heart, Lung and Blood Institute, the National Eye Institute, and the National Center for Research Resources, Bethesda, Maryland.

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