Relationship of Glycemia to Cardiovascular Disease ... - Lipids Online

DCCT-EDIC:
Long-term Risk of
Macrovascular Complications
Hemoglobin A 1C
12%
10%
8%
6%
Conventional
Intensive
P < 0.001 P < 0.001 P = 0.61
Cumulative Incidence
0.12
0.10
0.08
0.06
0.04
0.02
Any Cardiovascular Outcome
42% risk reduction
P = 0.02
Conventional
Intensive
DCCT
End of
Randomized
Treatment
EDIC
Year 1
EDIC
Year 7
0.00
0 2 4 6 8 10 12 14 16 18 20
Years Since Entry*
*Diabetes Control and Complications Trial (DCCT) ended and Epidemiology of Diabetes
Interventions and Complications (EDIC) began in year 10 (1993). Mean follow-up: 17 years.
DCCT/EDIC Research Group. JAMA. 2002;287:2563-2569. Copyright © 2002
American Medical Association. All rights reserved. | Nathan DM, et al. N Engl J
Med. 2005;353:2643-2653. Copyright © 2005 Massachusetts Medical Society.
All rights reserved.
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DCCT-EDIC: Long-term Risk of Macrovascular Complications
At the end of the randomized treatment phase in the Diabetes Control and Complications
Trial, the research group found a difference in the concentration of hemoglobin A 1c
between the patients with type 1 diabetes in the intensive treatment group and those in the
conventional treatment group. At the end of the trial, there was a nonsignificant reduction
in cardiovascular outcome in the intensively treated group. The trial ended at
approximately 9 years; afterward, there was convergence of treatments and similar levels
of glycemic control were achieved. There was persistent benefit, however, among the
intensively treated group such that there was a statistically significant reduction in
cardiovascular disease when compared to the conventionally treated group in the followup
phase (up to 20 years) of the study. These data would indicate that 10 years of
intensive treatment yielded a cardiovascular benefit during the first 10 years that was
sustained and became greater in the follow-up phase.
References:
Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and
Complications Research Group. Effect of intensive therapy on the microvascular
complications of type 1 diabetes mellitus. JAMA. 2002;287:2563-2569.
Nathan DM, Cleary PA, Backlund JY, et al, for the Diabetes Control and Complications
Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study
Research Group. Intensive diabetes treatment and cardiovascular disease in patients with
type 1 diabetes. N Engl J Med. 2005;353:2643-2653.
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