Progression of carotid artery intima-media thickness during 12 years in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study

Joseph F Polak, Jye-Yu C Backlund, Patricia A Cleary, Anita P Harrington, Daniel H O'Leary, John M Lachin, David M Nathan, DCCT/EDIC Research Group, Joseph F Polak, Jye-Yu C Backlund, Patricia A Cleary, Anita P Harrington, Daniel H O'Leary, John M Lachin, David M Nathan, DCCT/EDIC Research Group

Abstract

Objective: This study investigated the long-term effects of intensive diabetic treatment on the progression of atherosclerosis, measured as common carotid artery intima-media thickness (IMT).

Research design and methods: A total of 1,116 participants (52% men) in the Epidemiology of Diabetes Interventions and Complications (EDIC) trial, a long-term follow-up of the Diabetes Control and Complications Trial (DCCT), had carotid IMT measurements at EDIC years 1, 6, and 12. Mean age was 46 years, with diabetes duration of 24.5 years at EDIC year 12. Differences in IMT progression between DCCT intensive and conventional treatment groups were examined, controlling for clinical characteristics, IMT reader, and imaging device.

Results: Common carotid IMT progression from EDIC years 1 to 6 was 0.019 mm less in intensive than in conventional (P < 0.0001), and from years 1 to 12 was 0.014 mm less (P = 0.048); but change from years 6 to 12 was similar (intensive - conventional = 0.005 mm, P = 0.379). Mean A1C levels during DCCT and DCCT/EDIC were strongly associated with progression of IMT, explaining most of the differences in IMT progression between DCCT treatment groups. Albuminuria, older age, male sex, smoking, and higher systolic blood pressure were significant predictors of IMT progression.

Conclusions: Intensive treatment slowed IMT progression for 6 years after the end of DCCT but did not affect IMT progression thereafter (6-12 years). A beneficial effect of prior intensive treatment was still evident 13 years after DCCT ended. These differences were attenuated but not negated after adjusting for blood pressure. These results support the early initiation and continued maintenance of intensive diabetes management in type 1 diabetes to retard atherosclerosis.

Trial registration: ClinicalTrials.gov NCT00360815.

Figures

FIG. 1.
FIG. 1.
Least squares means in common carotid artery IMT based on linear mixed model adjusted for age, sex, study cohort, IMT reader, image device, and mean baseline IMT value of 0.614 mm. A significant separation in mean IMT between treatment groups (intensive, ■; conventional, ▲) emerged between years 1 and 6 (P < 0.0001) that persisted to year 12 (P = 0.048). From years 6 to 12, the progression rates are similar for the two treatment groups.

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