1. Intensive Diabetes Treatment
and Cardiovascular Disease in
Patients with Type 1 Diabetes
N Eng J Med 353;25: 2643 – 2653
DCCT: Diabetes Control and Complications Trial
EDIC: Epidemiology of Diabetes Interventions and Complications Study
Taz Babiker

2. Population
 Patients with type 1 diabetes
 Aged between 13 – 40 at randomisation
 Excluded
 Cardiovascular disease
 BP > 140/90
 Fasting cholesterol > 3 SD above age and sex-specific
means
 Mean 17 years follow up

3. Intervention
 ≥ 3 daily injections with insulin, OR
 Insulin pump
 4 self-monitored glucose measurements/24hrs
 Target glucose 3.9 – 6.7 mmol/l
 Target HbA1c < 6.05%
 At the end of DCCT, conventionally treated group offered
intensive treatment
 Differences between 2 groups less over 11 yrs of EDIC

4. Comparison
 Conventional therapy =
 No glucose goals beyond those needed to prevent
symptoms of hyperglycaemia and hypoglycaemia
 1-2 daily injections of insulin
 At the end of DCCT – 7.4% vs 9.1% (p<0.01)
 Conventional group offered intensive treatment
 HbA1c differences narrowed over 11 years of EDIC

5. Outcome
 Primary outcome = time to first cardiovascular event
 Non-fatal MI/stroke
 Death due to CVD
 Subclinical MI
 Angina
 Need for angioplasty/CABD
 Effect of HbA1c during EDIC was not assessed

10. Medications
 No medication history during DCCT but use of ACE
inhibitors discouraged and statins not available –
microalbuminuria associated with 2.5 x increased risk of
CVD
 Year 11 of EDIC – significant difference in use of betablockers: conventional 7% vs intensive 3% (p<0.05)

11. Discussion
 Should we intensively treat early then relax? i.e.
“metabolic memory”
 What role do beta blockers play in diabetes and
cardiovascular disease risk
 Low numbers of events
 Some CV events subjective
 High number of silent MIs