Changes in glycaemic control and risk of coronary artery disease in type 1 diabetes mellitus: findings from the Pittsburgh Epidemiology of Diabetes Complications Study (EDC)

Diabetologia. 2007 Nov;50(11):2280-8. doi: 10.1007/s00125-007-0797-7. Epub 2007 Sep 2.

Abstract

Aims/hypothesis: To complete a comparative analysis of studies that have examined the relationship between glycaemia and cardiovascular disease (CVD)/coronary artery disease (CAD) and perform a prospective analysis of the effect of change in glycosylated Hb level on CAD risk in the Pittsburgh Epidemiology of Diabetes Complications Study (EDC) of childhood-onset type 1 diabetes mellitus (n = 469) over 16 years of two yearly follow-up.

Methods: Measured values for HbA(1) and HbA(1c) from the EDC were converted to the DCCT-standard HbA(1c) for change analyses and the change in HbA(1c) was calculated (final HbA(1c) minus baseline HbA(1c)). CAD was defined as EDC-diagnosed angina, myocardial infarction, ischaemia, revascularisation or fatal CAD after medical record review.

Results: The comparative analysis suggested that glycaemia may have a stronger effect on CAD in patients without, than in those with, albuminuria. In EDC, the change in HbA(1c) differed significantly between CAD cases (+0.62 +/- 1.8%) and non-cases (-0.09 +/- 1.9%) and was an independent predictor of CAD.

Conclusions/interpretation: Discrepant study results regarding the relationship of glycaemia with CVD/CAD may, in part, be related to the prevalence of renal disease. Measures of HbA(1c) change over time show a stronger association with CAD than baseline values.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Blood Glucose / metabolism*
  • Body Mass Index
  • Coronary Disease / epidemiology*
  • Diabetes Mellitus, Type 1 / blood*
  • Diabetes Mellitus, Type 1 / complications*
  • Diabetic Angiopathies / epidemiology*
  • Female
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Pennsylvania
  • Risk Factors

Substances

  • Blood Glucose
  • Glycated Hemoglobin A