Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes

摘要

Insulin therapy has been suggested to reduce the incidence of long-term cardiovascular complications in patients with diabetes. This study investigated the degree and aggressiveness with which blood sugar should be reduced.Patients with type 1 diabetes and without cardiovascular disease (n = 1,422) were prospectively randomized to intensive therapy (target blood sugar 70-120 mg/dL) versus conventional therapy (prevention of symptoms of hyperglycemia) for 6.5 years. One thousand three hundred ninety-four of these patients were followed for a mean of 17 years. Outcomes were defined as nonfatal myocardial infarction, stroke, death from cardiovascular disease, angina, or need for coronary artery bypass graft surgery.At the end of the treatment period, mean glycosylated hemoglobin was 9.1% in the conventional group and 7.4% in the treatment group (p < 0.01). At the end of follow-up, 98 events occurred in 52 patients with conventional treatment and 46 events occurred in 31 patients with intensive therapy. Intensive treatment reduced the risk of any cardiovascular disease event by 42% (95% confidence interval [CI], 9%-63%; p = 0.02) and the risk of nonfatal myocardial infarction, stroke, or death from cardiovascular disease by 57% (95% CI, 12%-79%; p = 0.02).