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Diabetes Current Topics in Diabetes

Sweetheart Study: Reducing Heart Disease Risk in Type 1 Diabetes

Medically Reviewed On: June 20, 2003

By Christine Haran

People with type 1 diabetes may now have another reason to maintain tight control over their blood sugar levels: a reduced risk of heart disease. One of three types of diabetes, type 1, formerly called juvenile diabetes, is a disease that requires life-long injections of insulin. While researchers have extensively studied heart disease risk in people with type 2 diabetes, which occurs in adults, much less is known about the factors that contribute to heart disease risk in people with type 1 diabetes. A recent study, however, has found that intensive diabetes therapy appears to reduce the thickening of the blood vessels, a process that increases risk of heart attack and stroke.

The study, cochaired by Dr. David Nathan, professor of medicine at Harvard Medical School and director of the Diabetes Center at the Massachusetts General Hospital, was part of the Epidemiology of Diabetes Interventions and Complications study. This study followed patients from the Diabetes Control and Complications Trial (DCCT), which began enrolling patients in 1983. The DDCT population is the largest group of people with type 1 diabetes to have been studied for such a long period of time.

Over the years, researchers have collected information on participants' heart disease risk factors, such as their cholesterol levels and smoking status, as well as their blood sugar levels. By examining these risk factors, Dr. Nathan explains, researchers have been able to discern that high blood sugar seems to be related to the development of the blood vessel narrowing process called atherosclerosis. Below, Dr. Nathan discusses how this information can help people with type 1 diabetes and how close control may reduce their heart disease risk.

Why did you decide to look at heart disease risk factors in patients with type 1 diabetes?
Heart disease remains a major cause of mortality in type 1 diabetes as it is in type 2 diabetes. And we know really very little about it. This is a disease that has its major onset during youth and adolescence. If you consider that most people of that age are not having very much heart disease, any increase in heart disease in the type 1 diabetic population will be considerable.

How is the thickness of the carotid artery wall a measure of heart disease?
The carotid artery is the major artery that takes blood to your brain. The process of atherosclerosis, which is really the thickening of vessel walls that ultimately leads to blockage of those vessels, is the underlying process of stroke as well as heart disease. It's very difficult to measure the blood vessels in the heart directly, and in most relatively healthy populations, that's not a method you can use.

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