Update on cardiovascular outcomes at 30 years of the diabetes control and complications trial/epidemiology of diabetes interventions and complications study
Open accessAbstract
OBJECTIVE: To describe the beneficial long-term effects of an average of 6.5 years of intensive diabetes therapy (INT) in type 1 diabetes on measures of atherosclerosis, cardiac structure and function, and clinical cardiovascular events observed in the Diabetes Control and Complications Trial (DCCT) and the Epidemiology of Diabetes Interventions and Complications (EDIC) study. RESEARCH DESIGN AND METHODS: The DCCT was a randomized clinical trial of 1,441 participants assigned to receive INT or conventional therapy (CON). It was conducted between 1983–1993 with an average follow-up of 6.5 years. EDIC (1994–present) is an observational follow-up of the DCCT cohort. Cardiovascular events have been recorded throughout. During EDIC common carotid intima-media thickness (IMT) was measured with ultrasound, coronary artery calcification with computed tomography, and cardiac structure and function with cardiac magnetic resonance imaging. RESULTS: DCCT INT and lower levels of HbA1c during DCCT/EDIC were associated with thinner carotid IMT, less coronary calcification, and a lower incidence of clinical cardiovascular events including myocardial infarction, stroke, and cardiac death. While there were no significant differences in cardiac structure and function between the former INT and CON groups, they were significantly associated with higher HbA1c during DCCT/EDIC. CONCLUSIONS: DCCT INT and the attendant 6.5 years of lower HbA1c had long-term salutary effects on the development and progression of atherosclerosis and cardiovascular disease during the subsequent follow-up during EDIC.
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Over the last 25 years, people with type 1 diabetes have seen large drops in microvascular and macrovascular complication risks and better outcomes.
“In the past 25 years, among people with type 1 diabetes the risks of microvascular and macrovascular compli-cations have substantially decreased and outcomes have improved.125,126”
From Type 1 diabetes (2018) · cites this paper as [125]
The Introduction and Conclusions (page not specified) report substantial long-term benefits of intensive treatment for both microvascular disease and cardiovascular outcomes in the DCCT/EDIC participants with type 1 diabetes. They do not establish that complication risks declined over the past 25 years among people with type 1 diabetes generally; the comparison is intensive versus conventional treatment, not a population-wide trend over time. (LLM, conf=0.86)
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- Authors
- Lachin, J. M., Orchard, T. J., Nathan, D. M., & for the DCCT/EDIC Research Group
- Affiliations
- George Washington University (US)
- University of Pittsburgh (US)
- Harvard University (US)
- Corresponding author
- Lachin, John M.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2013-12-11
- Volume
- 37
- Issue
- 1
- Pages
- 39-43
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC3868002
- OpenAlex
- W2172157568
- Cited by
- 206
- References
- 21
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 3 · 2023: 10 · 2022: 11 · 2021: 15 · 2020: 15 · 2019: 21 · 2018: 15 · 2017: 23 · 2016: 34 · 2015: 27 · 2014: 15 · 2013: 2
- FWCI
- 20.49
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Diabetes Care (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (UL1TR000041, UL1TR000114, 5u01dk094157-13, UL1TR001449, UL1TR000457)
- National Institute of Diabetes and Digestive and Kidney Diseases (U01DK094176, U01-DK094157)
- National Center for Advancing Translational Sciences
- 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 › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- type 1 diabetes, intensive diabetes therapy, cardiovascular outcomes, atherosclerosis, carotid intima-media thickness, coronary artery calcification, HbA1c, myocardial infarction, stroke, cardiac structure and function, Diabetes Control and Complications Trial
- MeSH terms
- Adolescent, Adult, Aged, Blood Glucose, Calcinosis, Diabetes Mellitus, Type 1, Dose-Response Relationship, Drug, Female, Glycated Hemoglobin, Humans, Insulin, Male, Middle Aged, Risk Factors, Ultrasonography, Treatment Outcome, Atherosclerosis, Young Adult, Diabetic Cardiomyopathies, Carotid Intima-Media Thickness
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