Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA.
Diabetes. 2011 Feb;60(2):607-13. doi: 10.2337/db10-0296.
This study investigated the long-term effects of intensive diabetic treatment on the progression of atherosclerosis, measured as common carotid artery intima-media thickness (IMT).
A total of 1,116 participants (52% men) in the Epidemiology of Diabetes Interventions and Complications (EDIC) trial, a long-term follow-up of the Diabetes Control and Complications Trial (DCCT), had carotid IMT measurements at EDIC years 1, 6, and 12. Mean age was 46 years, with diabetes duration of 24.5 years at EDIC year 12. Differences in IMT progression between DCCT intensive and conventional treatment groups were examined, controlling for clinical characteristics, IMT reader, and imaging device.
Common carotid IMT progression from EDIC years 1 to 6 was 0.019 mm less in intensive than in conventional (P < 0.0001), and from years 1 to 12 was 0.014 mm less (P = 0.048); but change from years 6 to 12 was similar (intensive - conventional = 0.005 mm, P = 0.379). Mean A1C levels during DCCT and DCCT/EDIC were strongly associated with progression of IMT, explaining most of the differences in IMT progression between DCCT treatment groups. Albuminuria, older age, male sex, smoking, and higher systolic blood pressure were significant predictors of IMT progression.
Intensive treatment slowed IMT progression for 6 years after the end of DCCT but did not affect IMT progression thereafter (6-12 years). A beneficial effect of prior intensive treatment was still evident 13 years after DCCT ended. These differences were attenuated but not negated after adjusting for blood pressure. These results support the early initiation and continued maintenance of intensive diabetes management in type 1 diabetes to retard atherosclerosis.
本研究旨在探讨强化糖尿病治疗对动脉粥样硬化进展（以颈总动脉内膜-中层厚度（IMT）衡量）的长期影响。
共有 1116 名（52%为男性）参加了糖尿病控制与并发症试验（DCCT）长期随访的流行病学研究（EDIC）试验的参与者，在 EDIC 第 1、6 和 12 年进行了颈动脉 IMT 测量。平均年龄为 46 岁，在 EDIC 第 12 年时糖尿病病程为 24.5 年。通过控制临床特征、IMT 阅读者和成像设备，检验了 DCCT 强化治疗组和常规治疗组之间 IMT 进展的差异。
与常规治疗组相比，强化治疗组从 EDIC 第 1 年到第 6 年 IMT 进展减少了 0.019 毫米（P<0.0001），从第 1 年到第 12 年减少了 0.014 毫米（P=0.048）；但从第 6 年到第 12 年的变化相似（强化治疗组-常规治疗组=0.005 毫米，P=0.379）。DCCT 期间和 DCCT/EDIC 期间的平均 A1C 水平与 IMT 进展密切相关，解释了 DCCT 治疗组之间 IMT 进展差异的大部分原因。白蛋白尿、年龄较大、男性、吸烟和较高的收缩压是 IMT 进展的显著预测因素。
强化治疗在 DCCT 结束后 6 年内减缓了 IMT 进展，但此后并未影响 IMT 进展（6-12 年）。在 DCCT 结束 13 年后，先前强化治疗的有益效果仍然明显。这些差异在调整血压后有所减弱，但并未消除。这些结果支持在 1 型糖尿病中尽早开始并持续维持强化糖尿病管理，以延缓动脉粥样硬化的发生。
