Intensive Treatment for Type 1 Diabetes Cuts Cardiovascular Risk
]]>Type 1 diabetes]]> , which develops in younger people, is associated with a number of health complications, including damage to the eyes, nerves, and kidneys. In addition, people with diabetes have at least a 10-fold increased risk of developing cardiovascular disease compared to non-diabetics. Some researchers have linked high blood glucose (a sign of diabetes) and cardiovascular disease, but it was not yet clear whether aggressively lowering blood sugar could decrease cardiovascular risk.
A new study in the December 22, 2005 issue of the New England Journal of Medicine found that, compared with conventional treatment, intensive treatment for type 1 diabetes decreased the risk of having a cardiovascular event (e.g., ]]>heart attack]]> , ]]>stroke]]> ) by 42%
About the Study
This study included 1,441 people with type 1 diabetes. They were 13-40 years old when the study began, and did not have a history of cardiovascular disease, ]]>high blood pressure]]> , or ]]>high cholesterol]]> . Half of the participants were assigned to conventional treatment (1-2 insulin injections per day with a daily urine or blood glucose test), and the other half to intensive treatment (at least 3 insulin injections per day or an insulin pump, and at least four urine or blood glucose tests). The researchers followed the participants for an average of 17 years, comparing the effects of the treatment regimens on the risk of having a cardiovascular event (e.g., heart attack, stroke, death due to cardiovascular disease).
During the study, 31 (4%) of the participants in the intensive treatment group had 46 cardiovascular events, and 52 (7%) of the participants in the conventional therapy group had 98 cardiovascular events. Compared with conventional treatment, intensive treatment was associated with a 42% reduction in cardiovascular risk. Intensive treatment was even more effective against the most severe events (heart attack, stroke, and death from cardiovascular disease), reducing this risk by 57%.
How Does This Affect You?
These findings suggest that intensive treatment for type 1 diabetes significantly reduces the risk of having a cardiovascular event. In fact, the authors of this study say that the benefit of intensive treatment exceeds the benefits of other interventions, including cholesterol and blood pressure lowering medications.
This study strongly supports intensive treatment for people with type 1 diabetes (the authors conclude that “intensive therapy should be implemented as early as possible in people with type 1 diabetes”). Intensive treatment, however, is not without its drawbacks: it is difficult to sustain and increases the risk of hypoglycemia (symptoms due to excessively low blood glucose).
But what about ]]>type 2 diabetes]]> ? There is already considerable evidence linking cardiovascular risk with this far more common condition, and the results of a similarly designed study are expected to be published around 2009. Until then, it is certainly reasonable for type 2 diabetic patients to proceed under the assumption that intensive management is to their cardiovascular advantage.
American Diabetes Association
National Diabetes Education Program
NIH study will test best ways to lower risk of heart disease and stroke in adults with type 2 diabetes. National Institutes of Health website. Available at: http://www.nih.gov/news/pr/feb2003/nhlbi-20.htm . Accessed December 20, 2005.
The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. NEJM . 2005;353:2643-2653.
Last reviewed Dec 21, 2005 by ]]>Richard Glickman-Simon, MD]]>
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