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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Comment on Braffett et al. Association of Insulin Dose, Cardiometabolic Risk Factors, and Cardiovascular Disease in Type 1 Diabetes During 30 Years of Follow-up in the DCCT/EDIC Study. Diabetes Care 2019;42:657–664
SNAITH, J. R., Holmes-Walker, D. J., & Greenfield, J. R. (2019) · Diabetes Care · doi:10.2337/dc19-0730 · Cited by 2
Exploring the clinical features and complications of type 1 diabetes mellitus in Saudi Arabia: A retrospective analysis
Hayek, A. A., Robert, A. A., Alshablan, A., Al-Mutairi, A. M., Alanzi, E. I., Alarjan, F. M., Althurwi, H. A., AlAmri, K., Almshhen, N., Althibait, N. A., et al. (2025) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_1758_24 · Cited by 1
“[7,8] However, maintaining the optimal glycemic level under control is a huge challenge for pediatric patients, because the aspects of growth, puberty, and varying insulin sensitivity need to be factored in, as well.”
Intima-Media-Dicke
Schuchert, A. (2008) · Der Kardiologe · doi:10.1007/s12181-008-0103-z · Cited by 1
Update on Care of Children with Type 1 Diabetes
Majidi, S., & Maahs, D. M. (2012) · Advances in Pediatrics · doi:10.1016/j.yapd.2012.04.007 · Cited by 1
“Intensive glycemic control is also associated with slower progression of subclinical atherosclerosis such as intima-media thickness (IMT) compared with the conventional group in the DCCT trial [69].”
Result
Estudo do perfil hemodinâmico da artéria oftálmica em gestantes com diabetes mellitus gestacional
dos Anjos, G. D. F. R., Diniz, A. L. D., dos Santos, M. C., & Damian, N. G. C. (2012) · Revista Brasileira Ginecologia e Obstetrícia · doi:10.1590/s0100-72032012001000007 · Cited by 1
Revascularización coronaria en diabéticos: evidencias, indicaciones y complicaciones
Jiménez‐Quevedo, P., & Sabaté, M. (2007) · Revista Española de Cardiología Suplementos · doi:10.1016/s1131-3587(07)75780-1 · Cited by 1
Intervalo QT corrigido e fatores de risco tradicionais para doença aterosclerótica em pacientes com diabetes tipo 1
de Castro, S. H., Faria-Neto, H. C. C., & Gomes, M. B. (2007) · Arquivos Brasileiros de Endocrinologia & Metabologia · doi:10.1590/s0004-27302007000700019 · Cited by 1
Main Findings on Therapeutic Management of Lower Extremity Artery Disease
Carbonara, G. R. S., & Ciccone, M. M. (2015) · Cardiovascular Pharmacology Open Access · doi:10.4172/2329-6607.s1-001 · Cited by 1
Complications of diabetes: an unsolicited epigenetic memory
Gurusamy, N., Sukumaran, V., Alhazzani, A. A., Shatoor, A. S., Watanabe, K., & Shirai, M. (2015) · Diabesity · doi:10.15562/diabesity.2015.6
Role of Advanced Glycation End Products, Oxidative Stress, and Inflammation in Diabetic Vascular Complications
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Role of Epigenetics in the Complications Associated with Diabetes and Related Metabolic Disorders
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Improving Glycemic Control in Children with Diabetes through Implementation of Multidisciplinary Team Approach
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“Follow-up data from the DCCT through the Epidemiology of Diabetes Interventions and Complications (EDIC) trial indicates those 5-7 years of poor glycaemic control during adolescence and young adulthood, results in an increased risk for microvascular and macrovascular complications in the subsequent 6-10 years [14].”
Method
Enhanced inflammation in subgroups of metabolic syndrome irrespective of glycaemic status
Osman, M. T., Nasir, N. M., Ramli, A. S., Saimin, H., Rahman, T. H. A., Abdul-Razak, S., Ismail, Z., & Nawawi, H. M. (2018) · Journal of Fundamental and Applied Sciences · doi:10.4314/jfas.v9i6s.26
Poor glycemic control can lead to an early appearance of atherosclerosis in patients with type 1 diabetes - Can this be avoided by effective educational programs?
Rodacki, M. (2017) · Archives of Endocrinology and Metabolism · doi:10.1590/2359-3997000000304 · Cited by 1
Treatment of Type 1 Diabetes Mellitus in Adults
Retnakaran, R. R., & Zinman, B. (2015) · Elsevier eBooks · doi:10.1016/b978-0-323-18907-1.00044-5 · Cited by 1
Renal Microvascular Injury in Diabetes: RAGE and Redox Signaling
Coughlan, M. T., Cooper, M. E., & Forbes, J. M. (2006) · Antioxidants and Redox Signaling · doi:10.1089/ars.2007.9.ft-18 · Cited by 1
Assessment of carotid intima-media thickness in patients with type 2 diabetes mellitus and arterial hypertension
Бондарь, И. А., Demin, A. A., Шабельникова, О. Ю., & Onyanova, V. A. (2014) · Diabetes Mellitus · doi:10.14341/dm2014141-46 · Cited by 1
Childhood-onset Type 1 diabetes and cardiovascular disease
Perchard, R., & Amin, R. (2015) · Diabetes Management · doi:10.2217/dmt.14.61 · Cited by 1

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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