Coprogression of Cardiovascular Risk Factors in Type 1 Diabetes During 30 Years of Follow-up in the DCCT/EDIC Study

Abstract

Objective: The Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) study has demonstrated the beneficial effect of intensive therapy on atherosclerosis and clinical cardiovascular outcomes, while identifying hyperglycemia as a dominant risk factor for type 1 diabetes. The current analyses evaluate the extent to which glycemic exposure influences long-term changes in established risk factors for cardiovascular disease (CVD) among patients with type 1 diabetes.

Research design and methods: The DCCT study randomized 1,441 participants to receive intensive or conventional diabetes therapy; and after an average of 6.5 years of follow-up, 96% of the surviving cohort enrolled in the EDIC observational study for an additional 20 years of follow-up. Annual visits included a detailed medical history and physical examination. Blood and urine samples were collected and assayed centrally. Longitudinal models for repeated measurements were used.

Results: Higher HbA1c level was a significant correlate of the longitudinal changes in all of the traditional CVD risk factors over the 30-year follow-up. The strongest longitudinal associations were among the lipid measurements and concurrent glycemia.

Conclusions: A better understanding of the interrelationships between diabetes-related risk factors and traditional CVD risk factors may assist with the development of targeted treatment regimens for persons with type 1 diabetes who are at risk for CVD.

Trial registration: ClinicalTrials.gov NCT00360815 NCT00360893.

© 2016 by the American Diabetes Association.

Figures

Figure 1

Body weight and hemodynamic measures during the DCCT/EDIC study by original assignment to intensive or conventional treatment during the DCCT. Data are reported as the mean ± SE at each DCCT/EDIC study follow-up year (black lines, conventional treatment; gray lines, intensive treatment). The average mean values over time are presented in Table 1. The panels for pulse pressure and pulse rate also present the proportion of subjects receiving concurrent medication.

Figure 2

Lipid profile and glycemic control during the DCCT/EDIC study by original assignment to intensive or conventional treatment during the DCCT. Data are reported as the mean ± SE at each DCCT/EDIC study follow-up year (black lines, conventional treatment; gray lines, intensive treatment). The average mean values over time are presented in Table 1. The panel for LDL cholesterol also presents the proportion of subjects receiving concurrent medication. Triglyceride values were log transformed, and the geometric means are presented.