Effects of Prior Intensive Insulin Therapy on Cardiac Autonomic Nervous System Function in Type 1 Diabetes Mellitus
Key result
Prior intensive insulin therapy reduced the risk of incident cardiac autonomic neuropathy by 31% (OR 0.69; 95% CI 0.51-0.93) 13 to 14 years after trial closeout compared with conventional therapy.
Why the study?
Does prior intensive insulin therapy reduce the incidence of cardiac autonomic neuropathy in patients with type 1 diabetes mellitus?
Population
1226 subjects with type 1 diabetes mellitus from the DCCT cohort evaluated in EDIC year 13/14
Comparison
Prior intensive insulin therapy (during DCCT) vs Prior conventional insulin therapy (during DCCT)
Design
Cohort
Follow-up
13 to 14 years after DCCT closeout
Authors
Discussion
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Member takes
Implication
May support legacy benefits of intensive therapy in T1DM; leaves open need for confirmation in contemporary cohorts before practice change.
Key Points
- This research aims to evaluate how prior intensive insulin therapy affects cardiac autonomic nervous system function in individuals with type 1 diabetes.
- Follow-up of 1226 former subjects from the DCCT in EDIC year 13/14.
- Used logistic regression to calculate odds of incident cardiac autonomic neuropathy by treatment group.
- Measured autonomic functions including R-R variation and Valsalva ratio.
- Prevalence of cardiac autonomic neuropathy was 28.9% in the intensive therapy group vs. 35.2% in the conventional group (P=0.018).
- Adjusted R-R variation was significantly greater in the intensive group (29.9 vs. 25.9; P<0.001).
- Prior therapy reduced the risks of incident CAN by 31% (OR 0.69; 95% CI 0.51 to 0.93).
Study Design
Type
Cohort (n=1,226)
Structured PICO
Does prior intensive insulin therapy reduce the incidence of cardiac autonomic neuropathy in patients with type 1 diabetes mellitus?
P
Population
1226 subjects with type 1 diabetes mellitus from the DCCT cohort evaluated in EDIC year 13/14
I
Intervention
Prior intensive insulin therapy (during DCCT)
C
Comparator
Prior conventional insulin therapy (during DCCT)
O
Outcome
Prevalence and incidence of cardiac autonomic neuropathy (CAN) using the DCCT composite definition 13 to 14 years after DCCT closeoutcomposite
Main Result
Effect estimate: OR 0.69 (95% CI 0.51 to 0.93)
Absolute Event Rate: 28.9% vs 35.2%
p-value: p=0.018
Prior intensive insulin therapy provides long-term benefits in reducing the incidence of cardiac autonomic neuropathy in patients with type 1 diabetes up to 14 years after treatment.
Cite This Study
Pop‐Busui et al. (2009) conducted a cohort in Type 1 diabetes mellitus (n=1,226). Prior intensive insulin therapy vs. Prior conventional therapy was evaluated on Prevalence and incidence of cardiac autonomic neuropathy (CAN) (OR 0.69, 95% CI 0.51 to 0.93, p=0.018). Prior intensive insulin therapy reduced the risk of incident cardiac autonomic neuropathy by 31% (OR 0.69; 95% CI 0.51-0.93) 13 to 14 years after trial closeout compared with conventional therapy.