The DCCT Lives On! Intensive Glucose Control Halves Complications
The famous Diabetes Control and Complications Trial, known to its friends as the DCCT, was the first to prove the power of "intensive control" of blood glucose to reduce the complications of diabetes. Although the ten-year study ended in 1993, researchers have continued to follow about 90 percent of the nearly 1,500 original DCCT volunteers. And the follow-up study, called the Epidemiology of Diabetes Interventions and Complications (EDIC), is measuring up to its illustrious parent in terms of demonstrating the value of tight control. According to results published in the July 27, 2009 issue of the Archives of Internal Medicine, microvascular and cardiovascular complications of type 1 diabetes are cut in half for patients with near-normal glucose.
In the original DCCT, one group followed what was then a conventional glucose control regimen, injecting insulin once or twice a day before meals, with a single daily urine or blood glucose test. The second group, the intensive control group, was asked to keep their A1c level at 6% by using multiple daily insulin injections and frequent blood glucose monitoring. By the end of the trial, it was clear that the intensive control group had been able to prevent or delay the onset of eye, kidney, and cardiovascular complications.
The EDIC is following three groups: two of the groups consist of former DCCT participants, and the third group is composed of patients from another study who were matched by age, duration of diabetes, and degree of eye damage. And now, the EDIC is revealing how these participants are doing, three decades after the DCCT began. "After 30 years of diabetes, fewer than 1 percent of those receiving intensive glucose control in the DCCT have significantly impaired vision, kidney failure, or needed a limb amputation due to diabetes," noted Saul Genuth, M.D., in an NIH press release. Dr. Genuth, who co-chairs the EDIC study, added, "Tight control is difficult to achieve and maintain, but its benefits have changed the course of diabetes."
According to the EDIC, only 21 percent in the intensive control group had eye damage, whereas 50 percent of subjects in the conventional group had damage. The intensive group also had lower rates of kidney damage (9 percent, as compared to 25 percent for the conventional group) and cardiovascular disease events (9 percent compared to 14 percent).
NIDDK, part of the NIH, conducts and supports basic and clinical research and research training on some of the most common, severe and disabling conditions affecting Americans. The Institute's research interests include diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition, and obesity; and kidney, urologic and hematologic diseases. For more information, visit www.niddk.nih.gov.
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