Update on Cardiovascular Outcomes at 30 Years of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study
Key result
Intensive diabetes therapy cuts major CVD events ~42% vs conventional therapy in T1D.
- 42% risk reduction
- 95% CI 9-63
- P=0.016
- n=1,441
Why the study?
Does intensive diabetes therapy reduce major cardiovascular events in young patients with type 1 diabetes?
Population
1,441 participants with type 1 diabetes, mean age at baseline 27 years. Excluded: prior CVD, hypertension…
Comparison
Intensive diabetes therapy for an average of 6.5… vs Conventional therapy (CON)
Design
Cohort, randomized clinical trial, outcomes adjudicated and read centrally…
Follow-up
average of 18 years of follow-up in DCCT/EDIC
Authors
Discussion
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Implication
Intensive therapy may confer lasting CV protection in type 1 diabetes; extends DCCT findings yet leaves open need for confirmatory trials.
Study Design
Type
Observational (n=1,441)
Blinding
Outcomes read centrally, masked to therapy
Randomization
Randomized in initial DCCT phase
Multicenter
Yes
Structured PICO
Does intensive diabetes therapy reduce major cardiovascular events in young patients with type 1 diabetes?
P
Population
1,441 young adults with type 1 diabetes, free of prior cardiovascular disease, hypertension, or dyslipidemia, followed for an average of 18 years.
I
Intervention
Intensive diabetes therapy (INT) for an average of 6.5 years
C
Comparator
Conventional therapy (CON)
O
Outcome
Composite of major CVD events (time to first of: nonfatal myocardial infarction or stroke, cardiovascular death, confirmed angina, or revascularization [angioplasty, stent, or bypass], or silent MI on ECG)composite
Main Result
Effect estimate: 42% risk reduction (95% CI 9-63)
p-value: p=0.016
An average of 6.5 years of intensive diabetes therapy in young patients with type 1 diabetes provides long-term reductions in atherosclerosis progression and major cardiovascular events over 18 years of follow-up.
Limitations
- The original DCCT was not designed or powered to assess the difference between treatments on the risk of cardiovascular events
- Small number of cardiovascular events during the initial DCCT phase due to the young age and good health of the cohort
- Gadolinium enhancement for cardiac MRI could only be conducted in a subset of subjects with adequate renal function
Cite This Study
Lachin et al. (2013) conducted an observational in Type 1 diabetes (n=1,441). Intensive diabetes therapy vs. Conventional therapy was evaluated on Composite of major CVD events (nonfatal MI or stroke, cardiovascular death, confirmed angina, revascularization, or silent MI on ECG) (42% risk reduction, 95% CI 9-63, p=0.016). Intensive diabetes therapy reduced the risk of the primary composite cardiovascular outcome by 42% compared to conventional therapy in patients with type 1 diabetes over an average 18-year follow-up.