OBJECTIVE Intensive treatment (INT) of type 1 diabetes reduces the incidence of cardiovascular disease (CVD) events compared with conventional treatment (CONV), but it also results in more weight gain. Our objective was to examine whether excessive weight gain from INT of type 1 diabetes is independently associated with subsequent CVD events.

RESEARCH DESIGN AND METHODS Quartiles (Q) of weight gain in 1,213 participants aged 18 years and older at enrollment in the Diabetes Control and Complications Trial (DCCT) were determined within randomized treatment groups (INT vs. CONV) using change in BMI from baseline to the closeout DCCT visits. Effects of this weight gain on CVD risk factors and outcomes during an additional 20 years of observational follow-up were then determined.

RESULTS The Q4 INT group experienced greater proportional weight gain (median change in BMI, 6.08 kg/m²), increases in CVD risk factors, and need for medications for hypertension and lipids compared with the Q1–3 INT and comparable CONV groups. Over a mean of 26 years of follow-up, the numbers of major and total CVD events were not statistically different in Q4 compared with Q1–3 of either the INT or CONV group. By year 14, however, the incident CVD event curve became significantly higher in the Q4 INT group than in the Q1–3 INT groups (P = 0.024) and was similar to that for the CONV group.

CONCLUSIONS For the first 13 years after DCCT, INT for type 1 diabetes reduced macrovascular events compared with CONV, even when excessive weight gain occurred. After this, total CVD events significantly increased in the Q4 INT group, becoming equivalent to those in the CONV group. Longer follow-up is needed to determine whether this trend continues and results in more major CVD events.

目的与常规治疗 (CONV) 相比，1 型糖尿病强化治疗 (INT) 可以降低心血管疾病 (CVD) 事件的发生率，但也会导致体重增加更多。我们的目的是检查 1 型糖尿病 INT 导致的体重过度增加是否与随后的 CVD 事件独立相关。

研究设计和方法糖尿病控制和并发症试验 (DCCT) 中 1,213 名 18 岁及以上参与者的体重增加四分位数 (Q) 在随机治疗组（INT 与 CONV）内使用 BMI 从基线到结束 DCCT 访问。然后在另外 20 年的观察随访中确定体重增加对 CVD 危险因素和结果的影响。

结果与 Q1-3 INT 组和可比较的 CONV 组相比，Q4 INT 组的体重增加比例更大（BMI 变化中位数为 6.08 kg/m ² ），CVD 危险因素增加，并且需要治疗高血压和血脂的药物。在平均 26 年的随访中，无论是 INT 组还是 CONV 组，第 4 季度的主要和总 CVD 事件数量与第 1-3 季度相比没有统计学差异。然而，到第 14 年，第 4 季度 INT 组的 CVD 事件曲线显着高于第 1-3 季度 INT 组 ( P = 0.024)，并且与 CONV 组相似。

结论在 DCCT 后的前 13 年中，与 CONV 相比，1 型糖尿病的 INT 减少了大血管事件，即使发生体重过度增加。此后，第四季度 INT 组的 CVD 事件总数显着增加，与 CONV 组相当。需要更长时间的随访来确定这种趋势是否持续并导致更多重大CVD事件。