Cited by 815Diabetes Management and ResearchDiabetes, Cardiovascular Risks, and LipoproteinsCardiovascular Health and Disease Prevention

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Intensive Diabetes Therapy and Carotid Intima–Media Thickness in Type 1 Diabetes Mellitus

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The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group·2003·New England Journal of Medicine

DOI 10.1056/nejmoa022314PMC PMC2701300

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Abstract

BACKGROUND: Cardiovascular disease causes severe morbidity and mortality in type 1 diabetes, although the specific risk factors and whether chronic hyperglycemia has a role are unknown. We examined the progression of carotid intima-media thickness, a measure of atherosclerosis, in a population with type 1 diabetes. METHODS: As part of the Epidemiology of Diabetes Interventions and Complications (EDIC) study, the long-term follow-up of the Diabetes Control and Complications Trial (DCCT), 1229 patients with type 1 diabetes underwent B-mode ultrasonography of the internal and common carotid arteries in 1994-1996 and again in 1998-2000. We assessed the intima-media thickness in 611 subjects who had been randomly assigned to receive conventional diabetes treatment during the DCCT and in 618 who had been assigned to receive intensive diabetes treatment. RESULTS: At year 1 of the EDIC study, the carotid intima-media thickness was similar to that in an age- and sex-matched nondiabetic population. After six years, the intima-media thickness was significantly greater in the diabetic patients than in the controls. The mean progression of the intima-media thickness was significantly less in the group that had received intensive therapy during the DCCT than in the group that had received conventional therapy (progression of the intima-media thickness of the common carotid artery, 0.032 vs. 0.046 mm; P=0.01; and progression of the combined intima-media thickness of the common and internal carotid arteries, -0.155 vs. 0.007; P=0.02) after adjustment for other risk factors. Progression of carotid intima-media thickness was associated with age, and the EDIC base-line systolic blood pressure, smoking, the ratio of low-density lipoprotein to high-density lipoprotein cholesterol, and urinary albumin excretion rate and with the mean glycosylated hemoglobin value during the mean duration (6.5 years) of the DCCT. CONCLUSIONS: Intensive therapy during the DCCT resulted in decreased progression of intima-media thickness six years after the end of the trial.

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Result
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BackgroundResult
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Background
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“In the Diabetes Control and Complications Trial (DCCT), 1229 individuals (85%) with Type 1 diabetes had increased carotid intima–media thickness as compared with age- and sex-matched controls (Nathan et al., 2003), and similar findings have been observed in other clinical studies (Giannattasio et al.”
Result
Insulin treatment and cardiovascular disease; friend or foe? A point of view
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“These findings suggest that the effect of intensive glucose treatment on atherosclerosis needs 6 years to become apparent [53].”
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“The intensive therapy during the DCCT/EDIC study Powered by TCPDF (www.tcpdf.org) Insulins with oral antidiabetic agents and cardiovascular risk resulted in decreased progression of intima-media thickness 6 years after the end of the trial (Nathan et al 2003).”
Cell Type-specific Post-transcriptional Regulation of Production of the Potent Antiangiogenic and Proatherogenic Protein Thrombospondin-1 by High Glucose
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Treatment Goals in Diabetes
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Tracking atherosclerosis regression: a clinical tool in preventive cardiology
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Cardiovascular Benefits of Exogenous Insulin
Chaudhuri, A., Dandona, P., & Fonseca, V. A. (2012) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2012-1112 · Cited by 49
Initial therapy with the fixed‐dose combination of sitagliptin and metformin results in greater improvement in glycaemic control compared with pioglitazone monotherapy in patients with type 2 diabetes
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Folic acid supplementation normalizes the endothelial progenitor cell transcriptome of patients with type 1 diabetes: a case-control pilot study
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Beta-Cell Replacement for Type I Diabetes
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Eating patterns in adolescents with type 1 diabetes: Associations with metabolic control, insulin omission, and eating disorder pathology
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Type 1 Diabetes Mellitus
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Risk Factors for Subclinical Atherosclerosis in Diabetic and Obese Children
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Earlier intervention in type 2 diabetes: The case for achieving early and sustained glycaemic control
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New insights into the significance of microalbuminuria
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Causes of diabetic foot lesions
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Cardiovascular Autonomic Neuropathy, Sexual Dysfunction, and Urinary Incontinence in Women With Type 1 Diabetes
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Insulins: Past, Present, and Future
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Metabolic Syndrome: Therapeutic Considerations
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“DCCT/EDIC also found correlations of glycemic levels with measures of atherosclerosis, such as carotid intimamedia thickness (IMT) (13) and coronary artery calcification (CAC) (14).”
BackgroundInfluential
Differential Effects of Oral Hypoglycemic Agents on Glucose Control and Cardiovascular Risk
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“2005), and in the progression of intimal-thickness (Nathan et al. 2003).”
Background
Toxic stress, inflammation and symptomatology of chronic complications in diabetes
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Animal Models of Diabetic Macrovascular Complications: Key Players in the Development of New Therapeutic Approaches
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Authors: The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group
Corresponding author: The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 2003-06-05
Volume: 348
Issue: 23
Pages: 2294-2303
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejmoa022314
PMC: PMC2701300
OpenAlex: W1667957779
Cited by: 815
References: 46
Citations by year: 2026: 5 · 2025: 6 · 2024: 15 · 2023: 13 · 2022: 7 · 2021: 22 · 2020: 20 · 2019: 26 · 2018: 21 · 2017: 24 · 2016: 21 · 2015: 41 · 2014: 34 · 2013: 37 · 2012: 41
FWCI: 39.98
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: Bristol-Myers Squibb
Eli Lilly and Company
AstraZeneca
GlaxoSmithKline
National Institutes of Health (n01dk062204-003)
Genentech
National Institute of Diabetes and Digestive and Kidney Diseases (N01 DK062204)
National Center for Research Resources
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
Keywords: type 1 diabetes, intensive diabetes therapy, carotid intima-media thickness, atherosclerosis, cardiovascular risk, glycemic control, HbA1c, Diabetes Control and Complications Trial, carotid artery, LDL/HDL ratio, urinary albumin excretion, smoking, systolic blood pressure
MeSH terms: Adolescent, Adult, Analysis of Variance, Arteriosclerosis, Blood Glucose, Carotid Artery Diseases, Diabetes Mellitus, Type 1, Female, Follow-Up Studies, Humans, Lipids, Male, Risk Factors, Ultrasonography, Linear Models, Least-Squares Analysis, Case-Control Studies, Randomized Controlled Trials as Topic, Carotid Artery, Common, Tunica Intima, Tunica Media, Disease Progression

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Intensive Diabetes Therapy and Carotid Intima–Media Thickness in Type 1 Diabetes Mellitus

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