Effects of prior intensive insulin therapy on cardiac autonomic nervous system function in type 1 diabetes mellitus: the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study (DCCT/EDIC)

Rodica Pop-Busui; Phillip A Low; Barbara H Waberski; Catherine L Martin; James W Albers; Eva L Feldman; Catherine Sommer; Patricia A Cleary; John M Lachin; William H Herman; Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Intervention and Complications (EDIC) Research Group

doi:10.1161/CIRCULATIONAHA.108.837369

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Effects of prior intensive insulin therapy on cardiac autonomic nervous system function in type 1 diabetes mellitus: the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study (DCCT/EDIC)

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Effects of prior intensive insulin therapy on cardiac autonomic nervous system function in type 1 diabetes mellitus: the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study (DCCT/EDIC)

Rodica Pop-Busui, Phillip A Low, Barbara H Waberski, Catherine L Martin, James W Albers, Eva L Feldman, Catherine Sommer, Patricia A Cleary, John M Lachin, William H Herman, …

Circulation (New York, N.Y.), Vol.119(22), pp.2886-2893

06/09/2009

DOI: 10.1161/CIRCULATIONAHA.108.837369

PMCID: PMC2757005

PMID: 19470886

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Abstract

The Epidemiology of Diabetes Interventions and Complications (EDIC) study, a prospective observational follow-up of the Diabetes Control and Complications Trial (DCCT) cohort, reported persistent benefit of prior intensive therapy on retinopathy and nephropathy in type 1 diabetes mellitus. We evaluated the effects of prior intensive insulin therapy on the prevalence and incidence of cardiac autonomic neuropathy (CAN) in former DCCT intensive and conventional therapy subjects 13 to 14 years after DCCT closeout. DCCT autonomic measures (R-R variation with paced breathing, Valsalva ratio, postural blood pressure changes, and autonomic symptoms) were repeated in 1226 EDIC subjects in EDIC year 13/14. Logistic regression models were used to calculate the odds of incident CAN by DCCT treatment group after adjustment for DCCT baseline covariates, duration in the DCCT, and quantitative autonomic measures at DCCT closeout. In EDIC year 13/14, the prevalence of CAN using the DCCT composite definition was significantly lower in the former intensive group versus the former conventional group (28.9% versus 35.2%; P=0.018). Adjusted R-R variation was significantly greater in the former DCCT intensive versus the former conventional group (29.9 versus 25.9; P<0.001). Prior DCCT intensive therapy reduced the risks of incident CAN by 31% (odds ratio, 0.69; 95% confidence interval, 0.51 to 0.93) and of incident abnormal R-R variation by 30% (odds ratio, 0.70; 95% confidence interval, 0.51 to 0.96) in EDIC year 13/14. Although CAN prevalence increased in both groups, the incidence was significantly lower in the former intensive group compared with the former conventional group. The benefits of former intensive therapy extend to measures of CAN up to 14 years after DCCT closeout.

Diabetes Mellitus, Type 1 - epidemiology

Insulin - pharmacology

Prevalence

Follow-Up Studies

Autonomic Nervous System - drug effects

Diabetes Mellitus, Type 1 - physiopathology

Humans

Middle Aged

Blood Glucose

Male

Diabetes Mellitus, Type 1 - complications

Incidence

Diabetic Retinopathy - epidemiology

Adult

Female

Diabetic Nephropathies - epidemiology

Insulin - therapeutic use

Heart - innervation

Details

Title: Subtitle: Effects of prior intensive insulin therapy on cardiac autonomic nervous system function in type 1 diabetes mellitus: the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study (DCCT/EDIC)
Creators: Rodica Pop-Busui - University of Michigan, Department of Internal Medicine, Division of Metabolism, Endocrinology, Diabetes, Ann Arbor, MI, USA. rpbusui@umich.edu
Phillip A Low
Barbara H Waberski
Catherine L Martin
James W Albers
Eva L Feldman
Catherine Sommer
Patricia A Cleary
John M Lachin
William H Herman
Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Intervention and Complications (EDIC) Research Group
Contributors: H Culver Boldt (Contributor) - University of Iowa, Ophthalmology and Visual Sciences
Resource Type: Journal article
Publication Details: Circulation (New York, N.Y.), Vol.119(22), pp.2886-2893
DOI: 10.1161/CIRCULATIONAHA.108.837369
PMID: 19470886
PMCID: PMC2757005
NLM abbreviation: Circulation
ISSN: 0009-7322
eISSN: 1524-4539
Publisher: United States
Grant note: N01 DK062204-A / NIDDK NIH HHS R01 DK062218 / NIDDK NIH HHS N01 DK062204-007 / NIDDK NIH HHS
Language: English
Date published: 06/09/2009
Academic Unit: Ophthalmology and Visual Sciences
Record Identifier: 9983980023802771

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