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cardiovascular disease

What we know about preventing cardiovascular disease in type 1 diabetes

You may have heard of the landmark Diabetes Control and Complications Trial (DCCT). It was a study conducted in the 1980’s to evaluate the impact of “intensive” blood glucose control in type 1 diabetes (T1D) on the development of complications from diabetes. This study is the foundation of many of the current recommendations related to A1c targets and prevention of complications such as eye, kidney, nerve damage. Researchers at the time were keen to understand the cause of complications and what could be done to prevent this from happening in PWDs. The DCCT study found that achieving and maintaining near-normal blood glucose (A1c less than 7%) substantially reduces the risk of complications. Additionally, the results showed that for every “percent” that a hemoglobin A1C is above the 7% target, that the risk of developing eye, kidney, or nerve damage also increases (see chart below). The DCCT study is considered a major, groundbreaking discovery within diabetes at the time and continues to influence diabetes treatment today, nearly 35 years after it was completed.

chart

Since the preliminary DCCT trial, there have been several follow-up studies to continue building off the strong foundation from this initial work. The Epidemiology of Diabetes Interventions and Complications (EDIC) study has continued to follow the same group of T1D study participants over time (>35 years) to understand the impact of glucose control on the development of diabetes-related complications. There is a tremendous knowledge base in the ability to follow the same group of participants from before the onset of complications and in a measured, reliable way.

Recently, a study published in Diabetes Care studied the health history of these subjects to identify risk factors for detecting cardiovascular disease (CVD) within T1D, the leading cause of death in patients with T1D. Previous research has shown that the onset of kidney, eye and nerve damage may predict future onset of future (and more severe) CVD in T1D.

Today’s research is keen to identify if the onset of kidney, eye or nerve complications impact the onset of CVD and major events such as heart attack, stroke, chest pain, artery revascularization, or death. By continuing to follow the same DCCT participants for multiple decades and continually measuring their health (and changes therein), researchers were able to determine how best to predict and detect CVD in patients with longstanding T1D and how this related to other complications that developed within this same group.

This study found that:

  • CVD and major cardiovascular events were more likely to occur in individuals who had already developed microvascular complications from diabetes.
  • Those who were most likely to have CVD and major cardiovascular events had advanced retinopathy, kidney disease, cardiovascular autonomic neuropathy.
  • Kidney disease represented a 1.5-2 fold increase of future CVD
  • Unlike previous studies, the onset of retinopathy by itself was not a predictor of future CVD

Similar to diabetes therapies which seek to treat glucose intensively, the goal with CDV and kidney disease treatment is similar. The sooner you treat it, the better. Future research will likely focus on new therapies to preserve kidney function (beyond current intensive diabetes management therapies available today) as an approach to reduce CVD within T1D over time. Stay tuned…

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