Intensive diabetes control curbs heart risk

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For patients with type 1 diabetes, intensive therapy aimed at keeping blood sugar levels as near normal as possible has long-term benefits on their cardiovascular health, according to the latest results from the Diabetes Control and Complication Trial (DCCT) reported in this week’s New England Journal of Medicine.

Investigator Dr. David M. Nathan told Reuters Health that intensive therapy “has been accepted as the worldwide standard of therapy for type 1 diabetes since the demonstration by the DCCT that such therapy reduces by as much as 76 percent the development and progression of eye, nerve, and kidney disease.”

Now, he added, “further follow-up of the DCCT cohort, has shown a large benefit of intensive therapy on heart disease and stroke—the major killers in diabetes.”

In all, 1441 type 1 diabetics were treated with either intensive or conventional diabetes therapy for an average of 6.5 years between 1983 and 1993. The vast majority of participants were subsequently followed until the beginning of 2005.

During an average follow up of 17 years, there were 46 cardiovascular “events” in 31 patients in the intensive group compared with 98 events in 52 patients in the conventional group.

Intensive treatment reduced the risk of any cardiovascular disease event by 42 percent and the risk of nonfatal heart attacks, stroke, or death from cardiovascular disease by 57 percent, according to the team.

Summing up, Dr. Nathan said, “We can now tell patients with type 1 diabetes that intensive therapy will reduce all of the adverse outcomes that usually accompany the disease.”

“Intensive therapy,” he advised, “should be initiated as early in the course of diabetes as safely possible.”

SOURCE: New England Journal of Medicine, December 22, 2005.

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