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Earlier intensified insulin treatment of Type 1 diabetes and its association with long‐term macrovascular and renal complications
Author(s) -
Rathsman B.,
Donner M.,
Ursing C.,
Nyström T.
Publication year - 2016
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.12897
Subject(s) - medicine , diabetes mellitus , stroke (engine) , myocardial infarction , type 2 diabetes , insulin , macrovascular disease , cohort , incidence (geometry) , surgery , endocrinology , mechanical engineering , physics , optics , engineering
Abstract Aims To investigate the incidence of all‐cause mortality, composite mortality and morbidity in people with Type 1 diabetes formerly randomized in the Stockholm Diabetes Intervention Study. Methods A total of 102 people with Type 1 diabetes were randomized in the period 1982–1984 to intensified conventional treatment or standard treatment with insulin for a mean of 7.5 years. We prospectively re‐evaluated this cohort for the period until 2011 with regard to all‐cause mortality and composite mortality, which consisted of myocardial infarction, stroke and end‐stage renal disease as primary endpoints. Secondary endpoints were first‐time hospitalization for myocardial infarction and stroke or end‐stage renal disease. Data on HbA 1c levels (mean of 22 values/person) were retrospectively collected between 1996 and 2011. Results During the median follow‐up of 28 years, 22 people died: seven in the intensified conventional insulin group compared with 15 in the standard treatment group ( P = 0.30). With regard to composite mortality, six people in the intensified conventional insulin group died compared with 11 in the standard treatment group ( P = 0.56). For the secondary endpoints, 11 people in the intensified conventional insulin group developed myocardial infarction or stroke compared with 17 in the standard treatment group ( P = 0.72), and one person in the intensified conventional insulin compared with seven people in the standard treatment group developed end‐stage renal disease ( P = 0.09). Mean HbA 1c levels did not differ between groups during the follow‐up years. Conclusions All‐cause mortality, cardiovascular morbidity and progression to end‐stage renal disease did not differ in people with Type 1 diabetes earlier randomized to intensified insulin treatment.