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Beneficial effects of intensive therapy of diabetes during adolescence: outcomes after the conclusion of the Diabetes Control and Complications Trial (DCCT).

Abstract

OBJECTIVE

The Diabetes Control and Complications Trial (DCCT) demonstrated that intensive therapy of type 1 diabetes mellitus reduces the risk of development and progression of microvascular complications. The Epidemiology of Diabetes Interventions and Complications (EDIC) study assessed whether these benefits persisted after the end of DCCT. Results for the adolescent DCCT cohort are reported here.

STUDY DESIGN

Of the DCCT adolescent cohort (n = 195), 175 participated in EDIC, 151 had fundus photography, and 156 had albumin excretion rate measured at year 3 or 4. The odds of progression of retinopathy and albuminuria from closeout of the DCCT until EDIC year 4 were assessed.

RESULTS

In contrast to the 7.4 years of the DCCT, during which mean hemoglobin A(1c) levels were significantly lower with intensive therapy than conventional therapy (8.06% vs 9.76%; P <.0001), the subsequent first 4 years of EDIC had mean hemoglobin A(1c) levels that were similar between the former intensive and the former conventional groups (8.38% vs 8.45%). However, the prevalence of worsening of 3 steps or more in retinopathy and of progression to proliferative or severe nonproliferative retinopathy were reduced by 74% (P <.001) and 78% (P <.007), respectively, in the former intensive therapy group compared with the former conventional group.

CONCLUSIONS

These findings provide further support for the DCCT recommendation that most adolescents with type 1 diabetes receive intensive therapy aimed at achieving glycemic control as close to normal as possible to reduce the risk of microvascular complications.

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  • Authors+Show Affiliations

    ,

    Yale University School of Medicine, New Haven, CT, USA.

    , , , , ,

    Source

    The Journal of pediatrics 139:6 2001 Dec pg 804-12

    MeSH

    Adolescent
    Adult
    Albuminuria
    Cohort Studies
    Diabetes Mellitus, Type 1
    Diabetic Nephropathies
    Diabetic Retinopathy
    Female
    Fluorescein Angiography
    Glycated Hemoglobin A
    Humans
    Hypoglycemic Agents
    Insulin
    Male
    Odds Ratio
    Regression Analysis
    Time Factors
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    11743505

    Citation

    White, N H., et al. "Beneficial Effects of Intensive Therapy of Diabetes During Adolescence: Outcomes After the Conclusion of the Diabetes Control and Complications Trial (DCCT)." The Journal of Pediatrics, vol. 139, no. 6, 2001, pp. 804-12.
    White NH, Cleary PA, Dahms W, et al. Beneficial effects of intensive therapy of diabetes during adolescence: outcomes after the conclusion of the Diabetes Control and Complications Trial (DCCT). J Pediatr. 2001;139(6):804-12.
    White, N. H., Cleary, P. A., Dahms, W., Goldstein, D., Malone, J., & Tamborlane, W. V. (2001). Beneficial effects of intensive therapy of diabetes during adolescence: outcomes after the conclusion of the Diabetes Control and Complications Trial (DCCT). The Journal of Pediatrics, 139(6), pp. 804-12.
    White NH, et al. Beneficial Effects of Intensive Therapy of Diabetes During Adolescence: Outcomes After the Conclusion of the Diabetes Control and Complications Trial (DCCT). J Pediatr. 2001;139(6):804-12. PubMed PMID: 11743505.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Beneficial effects of intensive therapy of diabetes during adolescence: outcomes after the conclusion of the Diabetes Control and Complications Trial (DCCT). AU - White,N H, AU - Cleary,P A, AU - Dahms,W, AU - Goldstein,D, AU - Malone,J, AU - Tamborlane,W V, AU - ,, PY - 2001/12/18/pubmed PY - 2002/1/26/medline PY - 2001/12/18/entrez SP - 804 EP - 12 JF - The Journal of pediatrics JO - J. Pediatr. VL - 139 IS - 6 N2 - OBJECTIVE: The Diabetes Control and Complications Trial (DCCT) demonstrated that intensive therapy of type 1 diabetes mellitus reduces the risk of development and progression of microvascular complications. The Epidemiology of Diabetes Interventions and Complications (EDIC) study assessed whether these benefits persisted after the end of DCCT. Results for the adolescent DCCT cohort are reported here. STUDY DESIGN: Of the DCCT adolescent cohort (n = 195), 175 participated in EDIC, 151 had fundus photography, and 156 had albumin excretion rate measured at year 3 or 4. The odds of progression of retinopathy and albuminuria from closeout of the DCCT until EDIC year 4 were assessed. RESULTS: In contrast to the 7.4 years of the DCCT, during which mean hemoglobin A(1c) levels were significantly lower with intensive therapy than conventional therapy (8.06% vs 9.76%; P <.0001), the subsequent first 4 years of EDIC had mean hemoglobin A(1c) levels that were similar between the former intensive and the former conventional groups (8.38% vs 8.45%). However, the prevalence of worsening of 3 steps or more in retinopathy and of progression to proliferative or severe nonproliferative retinopathy were reduced by 74% (P <.001) and 78% (P <.007), respectively, in the former intensive therapy group compared with the former conventional group. CONCLUSIONS: These findings provide further support for the DCCT recommendation that most adolescents with type 1 diabetes receive intensive therapy aimed at achieving glycemic control as close to normal as possible to reduce the risk of microvascular complications. SN - 0022-3476 UR - https://www.unboundmedicine.com/medline/citation/11743505/Beneficial_effects_of_intensive_therapy_of_diabetes_during_adolescence:_outcomes_after_the_conclusion_of_the_Diabetes_Control_and_Complications_Trial__DCCT__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022347601604542 DB - PRIME DP - Unbound Medicine ER -