Early treatment of Type 1
Diabetes lowers cardiovascular disease risk
Newswise — Intensive and
early treatment of type 1 diabetes substantially lowers the
risk of cardiovascular ailments such as heart disease and
stroke, a new multicenter study shows.
Researchers at UT
Southwestern Medical Center and 27 other U.S. medical
institutions found that patients who receive early and
aggressive treatment for the disease, including the use of
insulin pumps or multiple daily (three or more) insulin
injections, glucose monitoring and lifestyle intervention as
young adults, reduced their risk of serious cardiovascular
disease by almost 60 percent.
Their findings are based
on a long-term study of patients who took part in the
Diabetes Control and Complications Trial (DCCT) more than a
decade ago. UT Southwestern participated in the follow-up
clinical study of DCCT patients called the Epidemiology of
Diabetes Interventions and Complications (EDIC) study. EDIC
examined long-term effects of aggressive treatment compared
with conventional blood glucose control. The latest findings
appear in today’s issue of the New England Journal of
Medicine.
The initial DCCT results,
announced in 1993, showed that intensive glucose control
prevents or delays eye, nerve and kidney damage – common
complications of type 1 diabetes. At the time, however,
researchers had not followed participants long enough to
investigate whether intensive treatment also lowered the
risk of heart attack and stroke.
“We were one of the
centers following about 60 patients, and when we started
most of our patients were, on average, 30 to 35 years old,”
said Dr. Philip Raskin, professor of internal medicine and
the lead DCCT researcher at UT Southwestern. “We reported
short-term health benefits of early, intensive treatment,
but at that time the patients weren’t old enough to
experience some of the cardiovascular disease and events
that can afflict older patients with type 1 diabetes. As
that population has aged, the strategy of early intervention
and aggressive control of the disease has shown tremendous
health advantages.”
The original National
Institutes of Health-funded trial began in 1983 and enrolled
1,441 people throughout the country. At that time,
management of type 1 diabetes usually consisted of a few
daily insulin injections and daily blood or urine glucose
screening. Researchers enrolled patients between the ages of
13 and 39 and those randomly assigned to intensive treatment
were asked to keep glucose levels as close to normal as
possible.
After six years, the group
of patients undergoing intensive treatment had
longer-lasting health benefits than conventionally treated
patients. They had fewer health complications, and their
blood glucose levels were lower. Aggressive management of
diabetes in the patients showed a 58 percent reduction in
the risk of serious cardiovascular events such as heart
attacks and strokes.
Dr. Raskin said that among
the volunteers continuing to participate in the study, the
aggressively treated patients had less than half the number
of cardiovascular events than the conventionally treated
group.
Type 1 diabetes typically
affects younger individuals and is usually diagnosed before
the age of 40. Most patients are diagnosed by the age of 14.
Type 1 diabetes – which affects about 1 million people in
the United States – is associated with a lack of insulin.
Pancreatic islet cells quit producing insulin in the
quantities needed to maintain a normal blood glucose level,
and patients must regiment their diets and take insulin
daily to metabolize blood glucose.
Type 1 diabetes accounts
for between 5 percent and 10 percent of all diabetes cases.
Diabetes is the most common cause of blindness, kidney
failure and amputations in adults and a major cause of heart
disease and stroke.
“We don’t know why type 1
diabetes causes these complications. People who have it seem
to have more problems with cardiovascular disease,
particularly women,” Dr. Raskin said. “But now we know with
intensive treatment, we can reduce this risk considerably.”
The EDIC study was funded
by the NIH.