Viewpoint: Intensive Diabetes Therapy Has Heart Benefits
This viewpoint offers commentary on important clinical research in the area of pharmacy.
Nathan DM, Cleary PA, Backlund JY, et al
N Engl J Med. 2005;353(25):2643-2653
The complications of diabetes cause significant morbidity and mortality (such as heart disease, kidney disease, neuropathy/nerve damage, vision changes, skin problems, and foot ulcers). The presence of hyperglycemia is considered an important factor in the development of these complications.
The Diabetes Control and Complications Trial (DCCT) and the Epidemiology of Diabetes Interventions and Complications (EDIC) Study Research Group evaluated the effect of intensive glucose control (3 or more injections of insulin per day, or use of an insulin pump with dosage adjustment based on at least 4 self-measured glucose measurements per day) on the development and progression of diabetic complications. The results indicated that intensive therapy that achieves glucose control close to that of nondiabetic patients is beneficial, reducing the risk of complications such as retinopathy, neuropathy, and nephropathy.
Because cardiovascular disease has a higher prevalence in patients with diabetes than in patients without diabetes, it has been suggested that hyperglycemia contributes to the development of cardiovascular disease. Long-term follow-up data from the DCCT study were examined to determine whether intensive therapy reduces the risk of cardiovascular complications.
A total of 1422 patients completed the DCCT study (mean follow-up of 6.5 years). Ninety-seven percent of these patients were included in the EDIC long-term follow-up study. For the cardiovascular analysis, data from 96% of the surviving participants were included in the data pool. No significant differences in cardiovascular risk factors between the intensive-treatment and conventional treatment groups were evident; a minimally significant higher systolic blood pressure in the conventional treatment group was noted.
Eighty-three patients experienced 144 cardiovascular events during the mean 17 years of follow-up: 0.38/100 patient-years in the intensive treatment group, and 0.8/100 patient-years in the conventional treatment group. The risk of any cardiovascular disease event was reduced by 42% (P = .02) with intensive therapy. The risk of nonfatal myocardial infarction, stroke, or death from cardiovascular disease was reduced by 57% with intensive treatment (P = .02).
Intensive diabetes therapy has long-term cardiovascular benefits for patients with type 1 diabetes. Pharmacists and other clinicians can use long-term data such as these to help promote adherence to prescribed therapies. Providing patients with information about the long-term benefits may help them understand the importance of adhering to treatment regimens.
Abstract