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Higher HbA1c associated with long-term CVD risk changes in type 1 diabetes
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Higher HbA1c levels were significantly linked with longitudinal changes in traditional risk factors for cardiovascular disease in patients with type 1 diabetes over the course of 30 years, according to data from the Diabetes Control and Complications Trial and the Epidemiology of Diabetes and Complications study.
“Type 1 diabetes has been associated with an increased risk of CVD morbidity and mortality,” Barbara Braffett, PhD, of the Biostatistics Center, George Washington University, and colleagues wrote. “Despite improvements in risk factor profiles and robust treatment recommendations aimed at preventing diabetes-related complications, CVD remains the leading cause of death among individuals with type 1 diabetes, and increased risk of CVD is a major health concern.”
Researchers studied participants who enrolled in the Diabetes Control and Complications Trial (DCCT) between 1983 and 1989, then enrolled in the Epidemiology of Diabetes and Complications (EDIC) study in 1994 and continue to be followed (n = 1,251). Participants were divided into two cohorts in the DCCT: intensive therapy to keep blood glucose levels near a non-diabetic range or conventional type 1 diabetes treatment. The researchers obtained data from annual visits during the DCCT and EDIC study.
Over the course of 30 years, participants assigned to conventional treatment had a higher overall mean pulse rate (73 vs. 72 bpm; P = .0094), a higher triglyceride level (77 vs. 72 mg/dL, P = .0002), as well as higher HbA1c level (8.5% vs. 7.8%; P < .0001). The HbA1c level was accounted for by the design of the study, Braffett and colleagues wrote.
Participants in the intensive treatment group weighed significantly more over the course of the study than those in the conventional group, with men weighing an average of 5 kg and women an average of 4 kg more than their counterparts in the conventional group. Participants in the intensive treatment group had a higher overall BMI, lower pulse rate and lower triglyceride level than participants in the conventional treatment group.
“Over time, there were significant treatment group differences in a number of CVD risk factors and substantial associations with measures of HbA1c,” Braffett and colleagues wrote. “Although the significant association with current HbA1c level dominated, it did not completely mediate the treatment group differences for all factors. The greater understanding of the relationships among diabetes-related risk factors and established CVD risk factors may provide insight into the design of individualized comprehensive interventions for the control of comorbidities and the reduction of CVD risk in persons with type 1 diabetes.” – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.
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