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Association between 7 years of intensive treatment of type 1 diabetes and long-term mortality.

ABSTRACT: Whether mortality in type 1 diabetes mellitus is affected following intensive glycemic therapy has not been established.To determine whether mortality differed between the original intensive and conventional treatment groups in the long-term follow-up of the Diabetes Control and Complications Trial (DCCT) cohort.After the DCCT (1983-1993) ended, participants were followed up in a multisite (27 US and Canadian academic clinical centers) observational study (Epidemiology of Diabetes Control and Complications [EDIC]) until December 31, 2012. Participants were 1441 healthy volunteers with diabetes mellitus who, at baseline, were 13 to 39 years of age with 1 to 15 years of diabetes duration and no or early microvascular complications, and without hypertension, preexisting cardiovascular disease, or other potentially life-threatening disease.During the clinical trial, participants were randomly assigned to receive intensive therapy (n?=?711) aimed at achieving glycemia as close to the nondiabetic range as safely possible, or conventional therapy (n?=?730) with the goal of avoiding symptomatic hypoglycemia and hyperglycemia. At the end of the DCCT, after a mean of 6.5 years, intensive therapy was taught and recommended to all participants and diabetes care was returned to personal physicians.Total and cause-specific mortality was assessed through annual contact with family and friends and through records over 27 years' mean follow-up.Vital status was ascertained for 1429 (99.2%) participants. There were 107 deaths, 64 in the conventional and 43 in the intensive group. The absolute risk difference was -109 per 100,000 patient-years (95% CI, -218 to -1), with lower all-cause mortality risk in the intensive therapy group (hazard ratio [HR]?=?0.67 [95% CI, 0.46-0.99]; P?=?.045). Primary causes of death were cardiovascular disease (24 deaths; 22.4%), cancer (21 deaths; 19.6%), acute diabetes complications (19 deaths; 17.8%), and accidents or suicide (18 deaths; 16.8%). Higher levels of glycated hemoglobin (HbA1c) were associated with all-cause mortality (HR?=?1.56 [95% CI, 1.35-1.81 per 10% relative increase in HbA1c]; P?

SUBMITTER: Writing Group for the DCCT/EDIC Research Group

PROVIDER: S-EPMC4306335 | biostudies-literature | 2015 Jan

REPOSITORIES: biostudies-literature

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Association between 7 years of intensive treatment of type 1 diabetes and long-term mortality.

Orchard Trevor J TJ Nathan David M DM Zinman Bernard B Cleary Patricia P Brillon David D Backlund Jye-Yu C JY Lachin John M JM

JAMA 20150101 1

<h4>Importance</h4>Whether mortality in type 1 diabetes mellitus is affected following intensive glycemic therapy has not been established.<h4>Objective</h4>To determine whether mortality differed between the original intensive and conventional treatment groups in the long-term follow-up of the Diabetes Control and Complications Trial (DCCT) cohort.<h4>Design, setting, and participants</h4>After the DCCT (1983-1993) ended, participants were followed up in a multisite (27 US and Canadian academic ...[more]

PMID: 25562265

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Association between 7 years of intensive treatment of type 1 diabetes and long-term mortality.

Publications

Association between 7 years of intensive treatment of type 1 diabetes and long-term mortality.

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