Insights from the diabetes control and complications trial/epidemiology of diabetes interventions and complications study on the use of intensive glycemic treatment to reduce the risk of complications of type 1 diabetes.
OBJECTIVE
To analyze the long-term effects of early implementation of intensive glycemic treatment in patients with type 1 diabetes.


METHODS
Data from the Diabetes Control and Complications Trial (DCCT) and the Epidemiology of Diabetes Interventions and Complications (EDIC) followup study are reviewed, particularly in terms of reduction of diabetes-related complications.


RESULTS
In the DCCT, intensive intervention resulted in a 63% reduction in retinopathy progression, a 47% decrease in development of severe nonproliferative diabetic retinopathy, a 39% and 54% reduction in microalbuminuria and macroalbuminuria, respectively, and a 60% reduction in clinical neuropathy at 5 years. Aggressive early intervention before the manifestation of complications yielded the best results. In both intensive and conventional treatment groups in the DCCT, there was approximately a 40% reduction in risk of progression of retinopathy for each 10% proportional reduction in hemoglobin A1c (HbA1c). At the conclusion of the DCCT, participants learned about the results, and all were encouraged and helped to adopt intensive treatment. Thereafter, the HbA1c levels of the two groups rapidly approached each other and have not been significantly different for the past 5 years of the EDIC study.


CONCLUSIONS
The findings in the DCCT and the EDIC follow-up study support early intensive treatment in patients with type 1 diabetes, with the goal of maintaining HbA1c levels as close to normal as is safely possible, to achieve long-term beneficial effects on the risk of complications.
Genuth
Saul
S
Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
D000375:Aging; D000419:Albuminuria / Q000517:prevention & control; D001786:Blood Glucose / Q000032:analysis; D002318:Cardiovascular Diseases / Q000517:prevention & control; D048909:Diabetes Complications / Q000517:prevention & control*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000188:drug therapy*; D003928:Diabetic Nephropathies / Q000517:prevention & control; D003929:Diabetic Neuropathies / Q000517:prevention & control; D003930:Diabetic Retinopathy / Q000517:prevention & control; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage; D008239:Lysine / Q000031:analogs & derivatives / Q000032:analysis; D016032:Randomized Controlled Trials as Topic; D012867:Skin / Q000737:chemistry; D013997:Time Factors
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D008239:Lysine; C048496:N(6)-carboxymethyllysine