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Intensive diabetes treatment and cardiovascular outcomes in type 1 diabetes: The DCCT/EDIC study 30-year follow-up

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The Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Study Research Group·2016·Diabetes Care
DOI 10.2337/dc15-1990PMC PMC4839174
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Abstract

OBJECTIVE: Early initiation of intensive diabetes therapy aimed at achieving near-normal glycemia reduces the early development of vascular complications in type 1 diabetes. We now assess whether intensive therapy compared with conventional therapy during the Diabetes Control and Complications Trial (DCCT) affected the incidence of cardiovascular disease over 30 years of follow-up. RESEARCH DESIGN AND METHODS: The DCCT randomly assigned 1,441 patients with type 1 diabetes to intensive versus conventional therapy for a mean of 6.5 years, after which 93% were subsequently monitored during the observational Epidemiology of Diabetes Interventions and Complications (EDIC) study. Cardiovascular disease (nonfatal myocardial infarction and stroke, cardiovascular death, confirmed angina, congestive heart failure, and coronary artery revascularization) was adjudicated using standardized measures. RESULTS: During 30 years of follow-up in DCCT and EDIC, 149 cardiovascular disease events occurred in 82 former intensive treatment group subjects versus 217 events in 102 former conventional treatment group subjects. Intensive therapy reduced the incidence of any cardiovascular disease by 30% (95% CI 7, 48; P = 0.016), and the incidence of major cardiovascular events (nonfatal myocardial infarction, stroke, or cardiovascular death) by 32% (95% CI −3, 56; P = 0.07). The lower HbA1c levels during the DCCT/EDIC statistically account for all of the observed treatment effect on cardiovascular disease risk. Increased albuminuria was also independently associated with cardiovascular disease risk. CONCLUSIONS: Intensive diabetes therapy during the DCCT (6.5 years) has long-term beneficial effects on the incidence of cardiovascular disease in type 1 diabetes that persist for up to 30 years.

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  • In the post-DCCT follow-up of the EDIC cohort, participants previously randomized to the intensive treatment arm had a significant 57% reduction in the risk of the composite outcome of nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death compared with those previously randomized to the standard treatment arm.

    “In the post-DCCT follow-up of the EDIC cohort, participants previously randomized to the intensive treatment arm had a significant 57% reduction in the risk of the composite outcome of nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death compared with those previously randomized to the standard treatment arm (58).”

    From 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026. (2026) · cites this paper as [58]

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  • An HbA1c less than 7.0% or reducing HbA1c by 1.0% prevents complications.

    “An HbA1c of 7.0% or greater puts people with diabetes at risk of developing macrovascular and microvascular complications, whereas a HbA1c less than 7.0% or reducing HbA1c by 1.0% prevents complications [5,6].”

    From One drop | Mobile on iPhone and apple watch: an evaluation of hbA1c improvement associated with tracking self-care (2017) · cites this paper as [5]

    The Results report that lower mean HbA1c was associated with reduced cardiovascular-event risk, and the Conclusions report a cardiovascular benefit from intensive therapy in people with type 1 diabetes. The paper does not establish that HbA1c below 7.0%, or a 1.0-percentage-point reduction, prevents complications; its reported comparison is 8% versus 7.2%, and it describes reduced risk rather than prevention. (LLM, conf=0.89)

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  • An HbA1c of 7.0% or greater puts people with diabetes at risk of developing macrovascular and microvascular complications.

    “An HbA1c of 7.0% or greater puts people with diabetes at risk of developing macrovascular and microvascular complications, whereas a HbA1c less than 7.0% or reducing HbA1c by 1.0% prevents complications [5,6].”

    From One drop | Mobile on iPhone and apple watch: an evaluation of hbA1c improvement associated with tracking self-care (2017) · cites this paper as [5]

    The Abstract says hyperglycemia affects both microvascular and macrovascular complications, and the Results associate lower HbA1c with lower cardiovascular risk. The paper studies people with type 1 diabetes and does not establish 7.0% as a threshold at which complications develop; the Results compare 8.0% with 7.2% instead. Page numbers are not provided in our copy. (LLM, conf=0.87)

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  • In the DCCT cohort, there was a significant reduction in CV outcomes (42%), nonfatal myocardial infarct (MI), stroke and CV death (57%), as well as all-cause mortality (33%) in previously intensively treated participants compared with those who were previously in the standard arm.

    “In the DCCT cohort, there was a significant reduction in CV outcomes (42%), nonfatal myocardial infarct (MI), stroke and CV death (57%), as well as all-cause mortality (33%) in previously intensively treated participants compared with those who were previously in the standard arm (17)(18)(19).”

    From Targets for Glycemic Control (2018) · cites this paper as [19]

    The Conclusions (page unavailable) mention 42% fewer CVD outcomes and 57% fewer major cardiovascular events, but identify those figures as earlier follow-up results. For the paper’s 30-year follow-up, the Results report reductions of 30% and 32%, respectively; the 32% reduction was not statistically significant (P = 0.07). The passages found do not report a 33% reduction in all-cause mortality. (LLM, conf=0.88)

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  • Benefits of intensive insulin therapy persisted beyond the end of the trial despite equivalent glucose levels, and reductions in incident cardiovascular disease and mortality emerged with time.

    “These benefits persisted beyond the end of the trial despite equivalent glucose levels in the two groups (HbA 1c 8% [64 mmol/mol]) in the posttrial period; furthermore, reductions in incident cardiovascular disease and mortality in the intensively treated group emerged with time (40).”

    From The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (2021) · cites this paper as [40]

    The introduction reports that benefits persisted after the trial despite similar glycemic control during EDIC, and the Results report a 30% lower incidence of cardiovascular disease in the former intensive-treatment group. The Results show fewer cardiovascular deaths and suggest fewer fatal events, but they do not establish the claimed reduction in overall mortality; nor do they show that a mortality reduction emerged with time. (LLM, conf=0.86)

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Authors
The Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Study Research Group
Corresponding author
The Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Study Research Group
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2016-02-09
Volume
39
Issue
5
Pages
686-693
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc15-1990
PMC
PMC4839174
OpenAlex
W2346630656
Cited by
712
References
39
Citations by year
2026: 60 · 2025: 77 · 2024: 78 · 2023: 63 · 2022: 88 · 2021: 57 · 2020: 67 · 2019: 79 · 2018: 65 · 2017: 56 · 2016: 22
FWCI
74.38
Type
journal article
Language
en
Open access
Licence
www.diabetesjournals.org/site/license (vor, 266 d)
Locations
  • Diabetes Care (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Diabetes and Digestive and Kidney Disease
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
type 1 diabetes, tight glycemic control, cardiovascular disease, long-term cardiovascular outcomes, HbA1c, albuminuria, myocardial infarction, stroke, cardiovascular mortality, Diabetes Control and Complications Trial
MeSH terms
Adolescent, Adult, Cardiovascular Diseases, Diabetes Mellitus, Type 1, Female, Follow-Up Studies, Glycated Hemoglobin, Humans, Male, Risk Factors, Cohort Studies, Incidence, Young Adult

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