(14-02-06) Intensive glycemic control has long-term cardiac benefits

NEW YORK (Reuters Health) - Intensive diabetes therapy has long-term benefits on the cardiovascular health of patients with type 1 diabetes, according to long-term follow up of the Diabetes Control and Complication Trial (DCCT) cohort reported in the December 22nd issue of The New England Journal of Medicine.

Investigator Dr. David M. Nathan told Reuters Health that "Intensive therapy, with the goal of achieving glycemic control as close to the non-diabetic range as safely possible, has been accepted as the worldwide standard of therapy for type 1 diabetes since the demonstration by the DCCT that such therapy reduces by as much as 76 percent the development and progression of eye, nerve, and kidney disease."
"Now," he added, "further follow-up of the DCCT cohort, has shown a large benefit of intensive therapy on heart disease and stroke -- the major killers in diabetes."
In all, 1441 type 1 diabetics were treated with either intensive or conventional diabetes therapy for a mean of 6.5 years between 1983 and 1993. The vast majority of participants were subsequently followed until the beginning of 2005.
During an average follow up of 17 years, there were 46 cardiovascular events in 31 patients in the intensive group compared with 98 events in 52 patients in the conventional group. Intensive treatment reduced the risk of any cardiovascular disease event by 42% and the risk of nonfatal MI, stroke, or death from cardiovascular disease by 57%, according to the team.
Summing up, Dr. Nathan said that "we can now tell patients with type 1 diabetes that intensive therapy will reduce all of the adverse outcomes that usually accompany the disease."
"Intensive therapy, aiming for a glycosylated hemoglobin level of 7% or less," he added, "should be the therapy for most patients with type 1 diabetes and should be initiated as early in the course of diabetes as safely possible."
Dr. William I. Cefalu of Louisiana State University in Baton Rouge, in related editorial, notes that the medical community needs "better means, different strategies, and a different mind-set if we hope to improve and maintain glycemic control in patients with type 1 diabetes and minimize side effects."
In the absence of these, he concludes, "the translation of research findings from a landmark study" such as this one "may not alter clinical practice for many years."

Source : N Engl J Med 2005;353:2643-2653,2707-2708.

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