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Intensive Diabetes Therapy and Carotid Intima–Media Thickness in Type 1 Diabetes Mellitus
Open accessAbstract
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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“Intensive glycemic management resulting in lower A1C levels has also been shown to have a beneficial effect on cardiovascular disease (CVD) complications in type 1 diabetes (9,10)”
From Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy (2009) · cites this paper as [9]
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10-year follow-up of intensive glucose control in type 2 diabetes
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“One of the hallmarks of diabetes is insulin absence or resistance and subsequent hyperglycemia, impairing the protective capacity of the vessel wall [73], and resulting in enhanced endothelial permeability [1] and impaired NO synthase function [20].”
BackgroundNathan, D. M., & for the DCCT/EDIC Research Group (2014) · Diabetes Care · doi:10.2337/dc13-2112 · Cited by 1,832
Metadata
- 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
- 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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