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

N H White; P A Cleary; W Dahms; D Goldstein; J Malone; W V Tamborlane; Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group

doi:10.1067/mpd.2001.118887

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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)

Journal article

Peer reviewed

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

N H White, P A Cleary, W Dahms, D Goldstein, J Malone, W V Tamborlane and Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group

The Journal of pediatrics, Vol.139(6), pp.804-812

12/2001

DOI: 10.1067/mpd.2001.118887

PMID: 11743505

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Abstract

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. 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. 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. 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.

Glycated Hemoglobin A - analysis

Diabetic Nephropathies - etiology

Albuminuria - blood

Humans

Glycated Hemoglobin A - drug effects

Male

Diabetes Mellitus, Type 1 - complications

Diabetic Nephropathies - blood

Hypoglycemic Agents - administration & dosage

Time Factors

Adult

Female

Diabetic Retinopathy - etiology

Odds Ratio

Diabetic Nephropathies - prevention & control

Fluorescein Angiography

Hypoglycemic Agents - therapeutic use

Albuminuria - etiology

Insulin - administration & dosage

Treatment Outcome

Albuminuria - prevention & control

Diabetes Mellitus, Type 1 - drug therapy

Diabetic Retinopathy - blood

Regression Analysis

Diabetic Retinopathy - prevention & control

Diabetes Mellitus, Type 1 - blood

Adolescent

Insulin - therapeutic use

Cohort Studies

Details

Title: Subtitle: Beneficial effects of intensive therapy of diabetes during adolescence: outcomes after the conclusion of the Diabetes Control and Complications Trial (DCCT)
Creators: N H White - Yale University School of Medicine, New Haven, CT, USA
P A Cleary
W Dahms
D Goldstein
J Malone
W V Tamborlane
Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group
Resource Type: Journal article
Publication Details: The Journal of pediatrics, Vol.139(6), pp.804-812
Publisher: United States
DOI: 10.1067/mpd.2001.118887
PMID: 11743505
ISSN: 0022-3476
eISSN: 1097-6833
Grant note: N01 DK062204-007 / NIDDK NIH HHS
Language: English
Date published: 12/2001
Academic Unit: Ophthalmology and Visual Sciences
Record Identifier: 9983979948702771

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