Tight Blood Glucose Control is Good for Your Heart

The EDIC study showed that intensive blood glucose control significantly reduces risk of macrovascualr complications, such as heart attack or stroke.

Results from the Epidemiology of Diabetes Interventions and Complications (EDIC), study, a continuation of the Diabetes Control and Complication Trial (DCCT), have proven that intensive control has the same positive benefits for cardiovascular disease as for the microvascular complications of diabetes such as eye disease, kidney disease and nerve damage.

The DCCT study, conducted from 1983 to 1993 and funded by the National Institute of Diabetes and Digestive and Kidney Diseases, was the single largest driving force behind the decision to endorse a goal of tight control of blood glucose to prevent microvasular complications for people with type 1 diabetes. Before the DCCT there was no definitive evidence that maintaining better control was preferable.

Approximately 1,400 people aged 13 to 39 with type 1 diabetes were enrolled in DCCT in multiple centers across the United States, including the Joslin Diabetes Center.

Researchers compared the effects of standard management (2 daily injections of insulin plus dietary management), versus intensive management (multiple daily injections of long- and short-acting insulin or pump management, plus modifications in insulin doses based on food intake and exercise) on blood glucose control.

The goal for the intensive group was to keep A1C values close to 6 percent or less. The study showed that normalizing glucose levels as much as possible slows the onset and progression of microvascular problems, such as the eye, kidney, and nerve damage caused by diabetes. In fact, it demonstrated that any sustained lowering of blood glucose was beneficial no mater what the previous control had been.

The DCCT ended in 1993 but research on the study participants didn’t stop there. Over 90 percent of participants have continued in the EDIC trial.

Because participants were relatively young during the years of the DCCT there wasn’t adequate time for macrovasular complications such as cardiovascular disease to develop. EDIC has allowed researchers to compare cardiac outcome differences in participants who were assigned either conventional or intensive care during the DCCT.

The EDIC study is an epidemiological trial which means that participants do not get any intervention—researchers are studying the effects of previous interventions on future outcomes.

By 2003 the parameters used for the intensive control arm of the DCCT was standard care for type 1 diabetes and blood glucose levels between the two groups equilibrated. Despite this, those who received the intensive care during the study still had fewer cardiac events and continued to have better outcomes for microvascular complications as well. This was true even if blood glucose control had deteriorated in the years following the DCCT.

Just as DCCT proved that better control leads to better outcomes for microvascular complications, EDIC showed that Intensive blood glucose control reduces risk of macrovascualr complications significantly. For example, nonfatal heart attack, stroke or death from cardiovascular declined 57 percent.

EDIC is being used to look at more than just macrovasular complications. Researchers have been interviewing trial participants to study the effects of diabetes on cognition for example. By the time the study wraps up in the next year or so there is no telling how much more practical information we may have.

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4 Responses to Tight Blood Glucose Control is Good for Your Heart

  1. Pingback: Questions You Have About Type 1 Diabetes Diet Guidelines |

  2. Ann Marie Montello says:

    Having had this condition since age 11, and now being 59, doctors seemed concerned about eyes and kidneys during my younger years, and that was it. One rarely heard about diabetes affecting the heart. With normal weight and BP all my life, and good cholesterol, high HDL due to being an aerobics instructor for 30 years, and a normal LDL, plus never having smoked, and on a strict diabetic diet, Ihad a heart attack in my mid fifties that I never felt, and now have six stents in my arteries in my heart. How is this you ask?? Diabetes does it to some of us, and I hate admitting it. I told a friend of mine to go get a good checkup from a cardiiologist, but he had the attack too quickly and wound up with a stent also and his diabetes, on a pump was under great control. I have also been on a pump for 29 years but it was not the answer. I feel that our genes have a lot to do with what diabetics will have heart issues. I know diabetics who have never watched their intake of anything most of their lives and never had an issue with anything diabetes related today. I thank God I was able to have two beautiful and healthy kids thirty plus years ago. I was lucky to have great and caring docs who knew how to handle type 1 diabetes and high risk pregnancies, before we had home glucose monitoring and pumps. Those days were a challenge for any diabetic and any diabetologist. I guess i should feel positive about good eyes and kidneys right? God Bless all with this disease! We must always admit that it could be much worse.

    • Ann Marie,
      Thank you for your comment. We actually have a researcher here at Joslin named Myra Lipes who is studying the relationship between the autoimmunity associated with type 1 diabetes and heart attacks. Joslin Communications is working on a series that will highlight research from around the center, and Dr. Lipes’ work will be covered in the next year. Please keep checking back to learn more!

  3. Ann Marie Montello says:

    That is great news! I will be looking forward to findings.
    AM

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