NATURAL HISTORY OF TYPE 1 DIABETES: EFFECT OF INTENSIVE MANAGEMENT – MACROVASCULAR DISEASE

The DCCT cohort was less than 39 years old at entry and was followed for only a mean of 6.5 years. Epidemiologic data had previously suggested that coronary artery disease may become apparent in most type 1 patients only after age 40. Therefore, the macrovascular disease rates in the DCCT were low, and no significant differences between intensive vs. standard management were seen. However, trends suggested a beneficial effect of intensive management to reduce the number of; pooled major macrovascular events. An event was defined as death secondary to cardiovascular disease or sudden death, acute myocardial infarction, coronary artery bypass surgery or angioplasty, angina confirmed by angiography, or ischemic changes on noninvasive testing. In addition, major cardiovascular events (fatal or nonfatal stroke) and major peripheral vascular events (amputation, bypass or angioplasty, or claudication with objective evidence) were included.
The number of macrovascular events (40) in the conventionally treated group was greater than that in the intensively treated group (23), but the differences were not statistically significant (p = 0.08). Mean total serum cholesterol and calculated low-density lipoprotein cholesterol were lower in the intensively treated group (p < 0.01), suggesting that long-term benefits may occur.
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