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3. Reducing HbA1c may avoid CVD events in type 1 diabetes

According to a study findings published in Diabetes Care intensive glucose management can help people with type 1 diabetes avoid an initial or subsequent cardiovascular disease or major adverse cardiovascular disease event. The availability of continuous glucose monitoring and more precise insulin delivery systems that proactively respond to hypoglycemia has improved the glucose control in individuals with type 1 diabetes and made it more achievable.

   Ionut Bebu, an associate research professor at the biostatistics center of The George Washington University in Rockville and his colleagues assessed the annual HbA1c, triglyceride and HDL cholesterol levels in 1,441 adults with type 1 diabetes from the Diabetes Control and Complications Trial(DCCT) and the Epidemiology of Diabetes Interventions and Complications(EDIC) study (mean age at baseline, 27 years; 47% women). The researchers also identified CVD events, such as CVD death, angina and congestive heart failure, using medical histories and electrocardiograms from 29 years of median follow-up time. The research team traced 421 CVD events among 239 participants and 149 major adverse cardiovascular events including CVD death, nonfatal myocardial infarction or nonfatal stroke among 120 participants.

   The study reported the strongest modifiable risk factor as HbA1c. Each 1% rise in mean HbA1c increased risk for an initial CVD event by 38%, subsequent CVD events by 28%, an initial major adverse cardiovascular event by 54% and subsequent major adverse CV events by 89%. In addition, a 5-year increase in age led to greater risks for a CVD event (HR = 1.46; 95% CI, 1.32-1.61), subsequent CVD events (IR = 1.18; 95% CI, 1.07-1.31), a major adverse CV event (HR = 1.53; 95% CI, 1.33-1.75) and subsequent major adverse cardiovascular events (IR = 1.69; 95% CI, 1.2-2.37).

   The researchers also found that each10 mm Hg increase in systolic blood pressure was tied to greater risks for a major adverse CV event (HR = 1.35; 95% CI, 1.11-1.66) and subsequent major adverse CV events (IR = 1.83; 95% CI, 1.14-2.95). The risk for subsequent major adverse CV events (IR = 0.19; 95% CI, 0.06-0.58) was reduced for those who used ACE inhibitors vs. those who did not. Therefore, intensive management of glycemia, use of antihypertensive medication, lipid control and smoking prevention/cessation are recommended to lower the risk of initial CVD events in subjects with type 1 diabetes.


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