ADA: Intensive Glycemic Control
Reduces Coronary Calcification: Atherosclerosis
Intensive glycaemic control is associated
with reduced coronary calcification, a marker
of atherosclerosis, years later -- even if control
has become less intense in the interim, according
to a new analysis.
John Lachin, ScD, Professor of Biostatistics
at George Washington University in Washington,
D.C., and principal investigator presented the
findings on behalf of the Diabetes Control and
complications Trial/Epidemiology of Diabetes Interventions
and Complications (DCCT/EDIC) Study Group at the
American Diabetes Association 63rd Scientific
Sessions.
Specifically, bringing blood glucose levels as
close to target levels as possible for an average
of 6.52 years yields reduced atherosclerosis risk
even after 8 years of less effective control,
compared with never achieving tight control, Dr.
Lachin said.
The DCCT, which began nearly 20 years ago, randomized
1,441 patients with type 1 diabetes to conventional
control with 1 to 2 insulin injections daily or
intensive control with at least 3 injections a
day or treatment with an insulin pump.
About 95% of the DCCT participants subsequently
enrolled in the EDIC observation study, where
they were evaluated annually for 8 years.
Dr. Lachin said that interim EDIC results showed
that after DCCT ended and patients were turned
over to their own physicians, HbA1c levels of
the two treatment groups started to drift together,
until both the conventionally and intensively
treated groups had average HbA1c levels of close
to 8%, Dr. Lachin said.
Nevertheless, he reported on June 14th that the
patients in the intensive control arm now have
significantly less calcification in their coronary
arteries than those who were on conventional control.
His team used computed tomography to assess the
coronary arteries of 1,150 patients originally
enrolled in DCCT, who had diabetes for an average
of 21 years.
After adjusting for gender, attained age, scanning
site, baseline retinopathy and smoking status,
people who were formerly in the conventional therapy
group were about 90% more likely to have a high
coronary calcification score -- defined as greater
than 200 Agatston units -- compared with those
on intensive therapy. And they were 52% more likely
to have a coronary calcification score greater
than 100 Agatston units, the study showed.
"Glycemia matters," Dr. Lachin said.
"It matters in the short-term, and it matters
especially in the long-term."
[Study title: Coronary Calcification in the Diabetes
Control and Complications Trial/Epidemiology of
Diabetes Interventions and Complications (DCCT/EDIC)
Cohort for the DCCT/EDIC Study Group. Abstract
652-P]
