Markers and Mechanisms of Macrovascular Disease in IDDM

BACKGROUND:

Macrovascular disease is the leading cause of death due to IDDM. Risk markers have been identified in non-diabetic populations, but may not apply to IDDM. The theme of the program project is that hyperglycemia interacts with specific factors to augment vascular risk and establish novel mechanisms of atherogenesis.

Patients under study originally participated in the DCCT, a recently concluded NIKKD clinical trial that demonstrated dramatic reductions in microvascular complications with intensive glucose control. The DCCT, conducted from 1983 to 1993 in 1,441 insulin dependent diabetes mellitus subjects at 209 medical centers, showed that keeping blood sugar levels as close to normal as possible slows the onset and progression of eye, kidney, and nerve diseases cause by diabetes.

The study is part of the initiative, The Etiology of Excess Cardiovascular Disease in Diabetes Mellitus, which was released in December 1995. The initiative originated after discussions between the NHLBI and the Juvenile Diabetes Foundation International (JDFI), a voluntary organization that supports research on diabetes. Both agreed that a combination of advances in understanding the etiology of diabetes and of cardiovascular diseases made this an oppportune time to stimulate further research to understand the reasons for the excessive macrovascular complications associated with diabetes.

DESIGN NARRATIVE: