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Intensive Diabetes Treatment and Cardiovascular Outcomes in Type 1 Diabetes: The DCCT/EDIC Study 30-Year Follow-up
Open accessAbstract
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 (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 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]
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“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]
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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 (17)(18)(19).”
From Targets for Glycemic Control (2018) · cites this paper as [19]
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“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]
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“The landmark Diabetes Control and Complications Trial and Epidemiology of Diabetes Interventions and Complications studies have demonstrated that intensive insulin therapy reduces the risk of both micro-and macro-vascular complications in people with T1D.1,2”
From Effectiveness of Semaglutide and Tirzepatide in Overweight and Obese Adults with Type 1 Diabetes (2025) · cites this paper as [1]
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“Additionally, longer-term epidemiological follow-up of these studies also showed a pattern of CVD benefit (58-60).”
From 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026. (2026) · cites this paper as [58]
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“The importance of glycemic management was demonstrated convincingly by the DCCT (39) and the Epidemiology of Diabetes Interventions and Complications (EDIC) follow-up study (40).”
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“The glycemic control portion of the trial was prematurely terminated after 3.5 years due to higher mortality (1.41% vs. 1.14% per year, HR 1.22) associated with assignment to the intensive-treatment arm (19,20).”
From Targets for Glycemic Control (2018) · cites this paper as [19]
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Metadata
- 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
- 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
- bronze
- doi.org
- 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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