Type 1 diabetes

Variability in benefit from intensive insulin therapy on cardiovascular events in individuals with type 1 diabetes: A post hoc analysis of the DCCT/EDIC study

Diabet MedPublished Post hoc analysis of the DCCT/EDIC study

Authors' conclusion

Although INT reduces the risk of MACE in the majority of individuals with type 1 diabetes, benefit varies substantially. These individual differences in the effect of INT underline the necessity for a better understanding of the individual response to intensive treatment.

Study context

Population
Individuals with T1D, participants of the DCCT/EDIC study
Participants
1,441 individuals
Comparison
Intensive insulin therapy vs conventional therapy
Primary endpoint
Treatment effect heterogeneity of INT on MACE
Methodological detailspenalized Cox regression model with treatment-by-covariate interaction terms, individual treatment effect estimation
  • Penalized Cox regression model with treatment-by-covariate interaction terms
  • Individual treatment effect estimation

Primary result

As reported in the abstract

Median absolute reduction in 30-year risk of MACE by group of predicted treatment effect

Predicted to benefit from insulin therapy (INT) for major adverse cardiovascular events (MACE) risk reduction

1279 individuals

89%

Group with no predicted benefit: median absolute reduction (i.e. risk increase), IQR −0.1% to −0.3%

−0.2%

Highest tertile of predicted benefit: median absolute reduction (i.e. risk reduction), IQR 3.8%-10.9%

6.6%

NNT, highest tertile of predicted benefit

15

Further findings

First MACE events

First MACE events observed
120

Benefit of preventing microvascular complications

Observed benefit stable across all subgroups of predicted MACE benefit

Original publication

Variability in benefit from intensive insulin therapy on cardiovascular events in individuals with type 1 diabetes: A post hoc analysis of the DCCT/EDIC study. Diabet Med. Published 24 July 2023. doi:10.1111/dme.15183

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