Intensive Diabetes Treatment
and Cardiovascular Disease in
Patients with Type 1 Diabetes
N Eng J Med 353;25: 2643 – 2653

...
Population

 Patients with type 1 diabetes
 Aged between 13 – 40 at randomisation
 Excluded
 Cardiovascular disease
 ...
Intervention
 ≥ 3 daily injections with insulin, OR

 Insulin pump
 4 self-monitored glucose measurements/24hrs
 Targe...
Comparison

 Conventional therapy =
 No glucose goals beyond those needed to prevent
symptoms of hyperglycaemia and hypo...
Outcome

 Primary outcome = time to first cardiovascular event
 Non-fatal MI/stroke
 Death due to CVD
 Subclinical MI
...
Medications

 No medication history during DCCT but use of ACE
inhibitors discouraged and statins not available –
microal...
Discussion

 Should we intensively treat early then relax? i.e.
“metabolic memory”
 What role do beta blockers play in d...
DCCT/EDIC - Type 1 diabetes - cardiovascular risk with intervention
DCCT/EDIC - Type 1 diabetes - cardiovascular risk with intervention
DCCT/EDIC - Type 1 diabetes - cardiovascular risk with intervention
DCCT/EDIC - Type 1 diabetes - cardiovascular risk with intervention
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DCCT/EDIC - Type 1 diabetes - cardiovascular risk with intervention

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DCCT/EDIC - Type 1 diabetes - cardiovascular risk with intervention

  1. 1. Intensive Diabetes Treatment and Cardiovascular Disease in Patients with Type 1 Diabetes N Eng J Med 353;25: 2643 – 2653 DCCT: Diabetes Control and Complications Trial EDIC: Epidemiology of Diabetes Interventions and Complications Study Taz Babiker
  2. 2. Population  Patients with type 1 diabetes  Aged between 13 – 40 at randomisation  Excluded  Cardiovascular disease  BP > 140/90  Fasting cholesterol > 3 SD above age and sex-specific means  Mean 17 years follow up
  3. 3. Intervention  ≥ 3 daily injections with insulin, OR  Insulin pump  4 self-monitored glucose measurements/24hrs  Target glucose 3.9 – 6.7 mmol/l  Target HbA1c < 6.05%  At the end of DCCT, conventionally treated group offered intensive treatment  Differences between 2 groups less over 11 yrs of EDIC
  4. 4. Comparison  Conventional therapy =  No glucose goals beyond those needed to prevent symptoms of hyperglycaemia and hypoglycaemia  1-2 daily injections of insulin  At the end of DCCT – 7.4% vs 9.1% (p<0.01)  Conventional group offered intensive treatment  HbA1c differences narrowed over 11 years of EDIC
  5. 5. Outcome  Primary outcome = time to first cardiovascular event  Non-fatal MI/stroke  Death due to CVD  Subclinical MI  Angina  Need for angioplasty/CABD  Effect of HbA1c during EDIC was not assessed
  6. 6. Medications  No medication history during DCCT but use of ACE inhibitors discouraged and statins not available – microalbuminuria associated with 2.5 x increased risk of CVD  Year 11 of EDIC – significant difference in use of betablockers: conventional 7% vs intensive 3% (p<0.05)
  7. 7. Discussion  Should we intensively treat early then relax? i.e. “metabolic memory”  What role do beta blockers play in diabetes and cardiovascular disease risk  Low numbers of events  Some CV events subjective  High number of silent MIs

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