title: Earlier intensified insulin treatment of Type 1 diabetes and its association with long-term macrovascular and renal complications.
abstract: OBJECTIVE
  To investigate the incidence of all-cause mortality, composite mortality and morbidity in people with Type 1 diabetes formerly randomized in the Stockholm Diabetes Intervention Study.
  
  
  METHODS
  A total of 102 people with Type 1 diabetes were randomized in the period 1982-1984 to intensified conventional treatment or standard treatment with insulin for a mean of 7.5 years. We prospectively re-evaluated this cohort for the period until 2011 with regard to all-cause mortality and composite mortality, which consisted of myocardial infarction, stroke and end-stage renal disease as primary endpoints. Secondary endpoints were first-time hospitalization for myocardial infarction and stroke or end-stage renal disease. Data on HbA1c levels (mean of 22 values/person) were retrospectively collected between 1996 and 2011.
  
  
  RESULTS
  During the median follow-up of 28 years, 22 people died: seven in the intensified conventional insulin group compared with 15 in the standard treatment group (P = 0.30). With regard to composite mortality, six people in the intensified conventional insulin group died compared with 11 in the standard treatment group (P = 0.56). For the secondary endpoints, 11 people in the intensified conventional insulin group developed myocardial infarction or stroke compared with 17 in the standard treatment group (P = 0.72), and one person in the intensified conventional insulin compared with seven people in the standard treatment group developed end-stage renal disease (P = 0.09). Mean HbA1c levels did not differ between groups during the follow-up years.
  
  
  CONCLUSIONS
  All-cause mortality, cardiovascular morbidity and progression to end-stage renal disease did not differ in people with Type 1 diabetes earlier randomized to intensified insulin treatment.
authors: Department of Clinical Science and Education, Sachs' Children's Hospital, Södersjukhuset, Stockholm, Sweden.
authors: B
authors: B
authors: Rathsman
authors: Department of Clinical Science and Education, Division of Internal Medicine, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
authors: M
authors: M
authors: Donner
authors: Department of Clinical Science and Education, Division of Internal Medicine, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
authors: C
authors: C
authors: Ursing
authors: Department of Clinical Science and Education, Division of Internal Medicine, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
authors: T
authors: T
authors: Nyström
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D016903:Drug Monitoring; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D015994:Incidence; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000150:complications / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D008137:Longitudinal Studies; D008297:Male; D009026:Mortality; D009203:Myocardial Infarction / Q000150:complications / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D012306:Risk; D020521:Stroke / Q000150:complications / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human