Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Oct 1;102(10):3704-3711.
doi: 10.1210/jc.2017-00589.

Association of Glycemic Control With Reduced Risk for Large-Vessel Disease After More Than 50 Years of Type 1 Diabetes

Liane J Tinsley  1 , Varant Kupelian  2 , Stephanie A D'Eon  1 , David Pober  1   3 , Jennifer K Sun  1   3 , George L King  1   3 , Hillary A Keenan  1   3
Affiliations

Association of Glycemic Control With Reduced Risk for Large-Vessel Disease After More Than 50 Years of Type 1 Diabetes

Liane J Tinsley et al. J Clin Endocrinol Metab. .

Abstract

Context: Previously we demonstrated, in individuals who have had type 1 diabetes (T1D) for 50 or more years (Medalists), that glycemic control was unrelated to diabetic complications, with the exception of cardiovascular disease (CVD), contrary to what has been documented in registry-based studies.

Objective: The purpose of this study is to validate these initial findings and identify contributors to mortality on an individual basis in a large cohort.

Design: Cross-sectional and longitudinal study.

Setting: Joslin Diabetes Center (JDC), Boston, Massachusetts.

Patients: 50-year Medalists presenting to JDC for study participation.

Interventions: None.

Main outcomes measures: Microvascular and macrovascular complications of diabetes and mortality.

Results: Glycemic control was not significantly associated with small-vessel complications in Medalists but was associated with CVD in the overall cohort, yet with varying effect by tertile of cohort duration. CVD was the largest contributor to mortality, whereas hemoglobin A1c was not an independent predictor of mortality either overall or substantially by diagnosis interval. Additionally, exercise mitigated mortality risk imparted by CVD.

Conclusions: Few large populations with long duration of (T1D) have been available to examine the effects of long-term exposure to hyperglycemia. These data indicate that an association of glycemic control, complications, and mortality may change in an older population with T1D. These results suggest that careful control is still warranted in older populations with T1D.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Effect of HbA1c on diabetic complications in multivariate logistic regression model. Graph showing the adjusted odds ratio on a 0.5 to 1.5 scale for a 1-mmol/mol increase in HbA1c on each complication by tertile of diabetes duration. The OR is significant for CVD in tertile 3 (P = 0.001) and for PDR in tertile 1 (P = 0.03). DN, diabetic nephropathy.
Figure 2.
Figure 2.
Distribution of causes of death in 50-Year Medalists compared with the US population aged ≥65 years. Two pie charts show the leading causes of death in the Medalist population (55.0% CVD, 16.3% cancer, and 11.2% complications of diabetes) compared with the leading causes of death in the US population aged ≥65 years in 2014 (31.7% CVD, 21.7% cancer, and 2.8% diabetes mellitus).
See this image and copyright information in PMC

References

    1. The relationship of glycemic exposure (HbA1c) to the risk of development and progression of retinopathy in the diabetes control and complications trial. Diabetes. 1995;44(8):968–983. - PubMed
    1. Effect of intensive diabetes management on macrovascular events and risk factors in the Diabetes Control and Complications Trial. Am J Cardiol. 1995;75(14):894–903. - PubMed
    1. Krolewski A. Epidemiology of late complications of diabetes. In: Kahn CR, Weir GD, eds. Joslin's Diabetes Mellitus. 13th ed. Philadelphia: Lea & Febiger; 1994:605–619.
    1. Miller RG, Secrest AM, Sharma RK, Songer TJ, Orchard TJ. Improvements in the life expectancy of type 1 diabetes: the Pittsburgh Epidemiology of Diabetes Complications study cohort. Diabetes. 2012;61(11):2987–2992. - PMC - PubMed
    1. Orchard TJ, Nathan DM, Zinman B, Cleary P, Brillon D, Backlund JY, Lachin JM; Writing Group for the DCCT/EDIC Research Group . Association between 7 years of intensive treatment of type 1 diabetes and long-term mortality. JAMA. 2015;313(1):45–53. - PMC - PubMed

Publication types

MeSH terms