EFFECT OF EXCESSIVE WEIGHT-GAIN WITH INTENSIVE THERAPY OF TYPE-1 DIABETES ON LIPID-LEVELS AND BLOOD-PRESSURE - RESULTS FROM THE DCCT

Context.-Intensive treatment of type 1 diabetes results in greater wei ght gain than conventional treatment. Objective.-To determine the effe ct of this weight gain on lipid levels and blood pressure. Design.-Ran domized controlled trial; ancillary study of the Diabetes Control and Complications Trial (DCCT). Setting.-Twenty-one clinical centers. Part icipants.-The 1168 subjects enrolled in DCCT with type 1 diabetes who were aged 18 years or older at baseline. Intervention.-Randomized to r eceive either intensive (n = 586) or conventional (n = 582) diabetes t reatment with a mean follow-up of 6.1 years. Main Outcome Measures.-Pl asma lipid levels and blood pressure in each treatment group categoriz ed by quartile of weight gain. Results.-With intensive treatment, subj ects in the fourth quartile of weight gain had the highest body mass i ndex (BMI) (a measure of weight adjusted for height), blood pressure, and levels of triglyceride, total cholesterol, low-density lipoprotein cholesterol (LDL-C), and apolipoprotein B compared with the other wei ght gain quartiles with the greatest difference seen when compared wit h the first quartile (mean values for the highest and lowest quartiles : BMI, 31 vs 24 kg/m(2); blood pressure, 120/77 mm Hg vs 113/73 mm Hg; triglyceride, 0.99 mmol/L vs 0.79 mmol/L [88 mg/dL vs 70 mg/dL]; LDL- C, 3.15 mmol/L vs 2.74 mmol/L [122 mg/dL vs 106 mg/dL]; and apolipopro tein B, 0.89 g/L vs 0.78 g/L; all P<.001). In addition, the fourth qua rtile group had a higher waist-to-hip ratio; more cholesterol in the v ery low density lipoprotein, intermediate dense lipoprotein, and dense LDL fractions; and lower high-density lipoprotein cholesterol and apo lipoprotein A-I levels compared with the first quartile. Baseline char acteristics were not different between the first and fourth quartiles of weight gain with intensive therapy except for a higher hemoglobin A ,, in the fourth quartile. Weight gain with conventional therapy resul ted in smaller increases in BMI, lipids, and systolic blood pressure. Conclusions.-The changes in lipid levels and blood pressure that occur with excessive weight gain with intensive therapy are similar to thos e seen in the insulin resistance syndrome and may increase the risk of coronary artery disease in this subset of subjects with time.