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According to a new analysis from DCCT, intensive glycemic control is associated with reduced coronary calcification, a marker of atherosclerosis, years later — even if control has become less intense in the interim.
John Lachin, ScD, professor of biostatistics at George Washington University in Washington, D.C., United States, 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 63rd Scientific Sessions of the American Diabetes Association.
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, showed that intensive control yielded an average hemoglobin A1c level of 7%, compared with 9% for conventional control. It also showed that reduced HbA1c levels were associated with a 39% to 76% reduction in risk of microvascular complications, including retinopathy, neuropathy, and nephropathy.
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 2 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 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]
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FACT: Nephropathy has no signs or symptoms in its early stages. Signs and symptoms usually occur after much damage has been done and include: Fluid buildup or retention, sleeplessness and tiredness, vomiting, weakness, hypertension, and extended period of hyperglycemia. That is why a microalbumin test should be done at diagnosis of Diabetes and also Prediabetes..