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)
Background— 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 mellitu...
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| Published in | Circulation (New York, N.Y.) Vol. 119; no. 22; pp. 2886 - 2893 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
09.06.2009
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0009-7322 1524-4539 1524-4539 |
| DOI | 10.1161/CIRCULATIONAHA.108.837369 |
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| Abstract | Background—
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.
Methods and Results—
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.
Conclusions—
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. |
|---|---|
| AbstractList | Background—
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.
Methods and Results—
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.
Conclusions—
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. 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.BACKGROUNDThe 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.METHODS AND RESULTSDCCT 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.CONCLUSIONSAlthough 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. 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. |
| Author | Feldman, Eva L. Herman, William H. Low, Phillip A. Waberski, Barbara H. Sommer, Catherine Pop-Busui, Rodica Martin, Catherine L. Lachin, John M. Albers, James W. Cleary, Patricia A. |
| Author_xml | – sequence: 1 givenname: Rodica surname: Pop-Busui fullname: Pop-Busui, Rodica organization: From the University of Michigan, Departments of Internal Medicine, Division of Metabolism, Endocrinology, Diabetes (R.P.-B., C.L.M., W.H.H.), and Neurology (J.W.A., E.L.F.), Ann Arbor; Mayo Clinic, Department of Neurology, Rochester, Minn (P.A.L., C.S.); and The Biostatistics Center, George Washington University, Rockville, Md (B.H.W., P.A.C., J.M.L.) – sequence: 2 givenname: Phillip A. surname: Low fullname: Low, Phillip A. organization: From the University of Michigan, Departments of Internal Medicine, Division of Metabolism, Endocrinology, Diabetes (R.P.-B., C.L.M., W.H.H.), and Neurology (J.W.A., E.L.F.), Ann Arbor; Mayo Clinic, Department of Neurology, Rochester, Minn (P.A.L., C.S.); and The Biostatistics Center, George Washington University, Rockville, Md (B.H.W., P.A.C., J.M.L.) – sequence: 3 givenname: Barbara H. surname: Waberski fullname: Waberski, Barbara H. organization: From the University of Michigan, Departments of Internal Medicine, Division of Metabolism, Endocrinology, Diabetes (R.P.-B., C.L.M., W.H.H.), and Neurology (J.W.A., E.L.F.), Ann Arbor; Mayo Clinic, Department of Neurology, Rochester, Minn (P.A.L., C.S.); and The Biostatistics Center, George Washington University, Rockville, Md (B.H.W., P.A.C., J.M.L.) – sequence: 4 givenname: Catherine L. surname: Martin fullname: Martin, Catherine L. organization: From the University of Michigan, Departments of Internal Medicine, Division of Metabolism, Endocrinology, Diabetes (R.P.-B., C.L.M., W.H.H.), and Neurology (J.W.A., E.L.F.), Ann Arbor; Mayo Clinic, Department of Neurology, Rochester, Minn (P.A.L., C.S.); and The Biostatistics Center, George Washington University, Rockville, Md (B.H.W., P.A.C., J.M.L.) – sequence: 5 givenname: James W. surname: Albers fullname: Albers, James W. organization: From the University of Michigan, Departments of Internal Medicine, Division of Metabolism, Endocrinology, Diabetes (R.P.-B., C.L.M., W.H.H.), and Neurology (J.W.A., E.L.F.), Ann Arbor; Mayo Clinic, Department of Neurology, Rochester, Minn (P.A.L., C.S.); and The Biostatistics Center, George Washington University, Rockville, Md (B.H.W., P.A.C., J.M.L.) – sequence: 6 givenname: Eva L. surname: Feldman fullname: Feldman, Eva L. organization: From the University of Michigan, Departments of Internal Medicine, Division of Metabolism, Endocrinology, Diabetes (R.P.-B., C.L.M., W.H.H.), and Neurology (J.W.A., E.L.F.), Ann Arbor; Mayo Clinic, Department of Neurology, Rochester, Minn (P.A.L., C.S.); and The Biostatistics Center, George Washington University, Rockville, Md (B.H.W., P.A.C., J.M.L.) – sequence: 7 givenname: Catherine surname: Sommer fullname: Sommer, Catherine organization: From the University of Michigan, Departments of Internal Medicine, Division of Metabolism, Endocrinology, Diabetes (R.P.-B., C.L.M., W.H.H.), and Neurology (J.W.A., E.L.F.), Ann Arbor; Mayo Clinic, Department of Neurology, Rochester, Minn (P.A.L., C.S.); and The Biostatistics Center, George Washington University, Rockville, Md (B.H.W., P.A.C., J.M.L.) – sequence: 8 givenname: Patricia A. surname: Cleary fullname: Cleary, Patricia A. organization: From the University of Michigan, Departments of Internal Medicine, Division of Metabolism, Endocrinology, Diabetes (R.P.-B., C.L.M., W.H.H.), and Neurology (J.W.A., E.L.F.), Ann Arbor; Mayo Clinic, Department of Neurology, Rochester, Minn (P.A.L., C.S.); and The Biostatistics Center, George Washington University, Rockville, Md (B.H.W., P.A.C., J.M.L.) – sequence: 9 givenname: John M. surname: Lachin fullname: Lachin, John M. organization: From the University of Michigan, Departments of Internal Medicine, Division of Metabolism, Endocrinology, Diabetes (R.P.-B., C.L.M., W.H.H.), and Neurology (J.W.A., E.L.F.), Ann Arbor; Mayo Clinic, Department of Neurology, Rochester, Minn (P.A.L., C.S.); and The Biostatistics Center, George Washington University, Rockville, Md (B.H.W., P.A.C., J.M.L.) – sequence: 10 givenname: William H. surname: Herman fullname: Herman, William H. organization: From the University of Michigan, Departments of Internal Medicine, Division of Metabolism, Endocrinology, Diabetes (R.P.-B., C.L.M., W.H.H.), and Neurology (J.W.A., E.L.F.), Ann Arbor; Mayo Clinic, Department of Neurology, Rochester, Minn (P.A.L., C.S.); and The Biostatistics Center, George Washington University, Rockville, Md (B.H.W., P.A.C., J.M.L.) |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/19470886$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1002/(SICI)1097-4598(199712)20:12<1561::AID-MUS11>3.0.CO;2-3 10.2337/diacare.24.2.339 10.2337/diacare.22.1.99 10.1212/WNL.52.3.523 10.2337/diacare.26.6.1895 10.1016/S0168-8227(96)90025-X 10.1001/jama.287.19.2563 10.1007/s00125-004-1617-y 10.1056/NEJMoa052187 10.1016/S0165-1838(96)00107-5 10.1212/WNL.46.5.1470 10.1056/NEJM199309303291401 10.2337/diacare.7.5.447 10.2337/diacare.26.5.1553 10.1161/circulationaha.106.634949 10.1001/jama.290.16.2159 10.2337/diabetes.51.2.514 10.1002/ana.410380607 10.2337/diacare.29.02.06.dc05-1549 10.1002/dmr.5610100403 10.1007/s001250050924 10.1007/BF01826212 10.2337/diab.31.4.339 10.1007/BF01826229 10.1016/S1056-8727(00)00054-4 10.1111/j.1464-5491.1992.tb01754.x |
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The Epidemiology of Diabetes Interventions and Complications (EDIC) study, a prospective observational follow-up of the Diabetes Control and... The Epidemiology of Diabetes Interventions and Complications (EDIC) study, a prospective observational follow-up of the Diabetes Control and Complications... |
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| SubjectTerms | Adult Autonomic Nervous System - drug effects Blood Glucose Diabetes Mellitus, Type 1 - complications Diabetes Mellitus, Type 1 - epidemiology Diabetes Mellitus, Type 1 - physiopathology Diabetic Nephropathies - epidemiology Diabetic Retinopathy - epidemiology Female Follow-Up Studies Heart - innervation Humans Incidence Insulin - pharmacology Insulin - therapeutic use Male Middle Aged Prevalence |
| Subtitle | The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study (DCCT/EDIC) |
| Title | Effects of Prior Intensive Insulin Therapy on Cardiac Autonomic Nervous System Function in Type 1 Diabetes Mellitus |
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