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The DCCT Lives On! Intensive Glucose Control Halves Complications


Sep 4, 2009

Researchers continued to follow about 90 percent of the nearly 1,500 original DCCT volunteers.

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.

The National Institutes of Health (NIH) - The Nation's Medical Research Agency - includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov


Categories: A1c Test, Blood Glucose, Community, Diabetes, Diabetes, Health, Insulin, Research, Type 1 Issues, Type 2 Issues



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Comments

Posted by Anonymous on 5 September 2009

good review but the DCCt was not the first to find this. Dr. R.L.Jackson published an article in 1953 with the same findings. Guthrie, Jackson & assoc. published similiar findings in J.Ophth. in 1970 with same findings as DCCT did in 1993. Give credit where credit is due.

Posted by Rick on 5 September 2009

guess what? if you don't have diabetes your risk for complications is 0%. so it stands to reason that the tighter your control the less your risk of complications. and how many people have died trying to accomplish this "goal"? this is absurd! a better use of this money would be to give it to people who don't have healthinsueance to buy pumps, meters, and supplies for both. quit wasting money on these ridiculous trials!

Posted by cjensen61 on 5 September 2009

Personally, Rick, I don;t agree with you at all. I want to know what I can do with this chronic disease (type 1) that will EXTEND my life and make it bearable. If I can read about studies they are continuing to do with tighter control, then maybe it can help me realize that tight control, although far from being easy to achieve, is worthwhile. I don't want to have to realize some day that if I had kept my disease under better control, I could have avoided amputation. Reading about what others have achieved inspires me to do ALL that I can do to make sure I keep my blood glucose as close to normal as possible. Living a life with as few complications as possible is a great goal that is truly possible. I cannot understand why anyone would think that these trials are "ridiculous." They are invaluable.

Posted by Anonymous on 5 September 2009

Rick,
I would recommend going back and reading the original protocal and objectives of the DCCT. You mentioned giving the money from such studies to people to buy insulin pumps, glucometers, test strips, and the like. There would have been no wide use of insulin pumps had it not been for the DCCT. It was that very study which tested the insulin pump in terms of intenstive therapy (at first the IP had to be worn on the back because of its size). I would say the greatest gain from the DCCT was KNOWLEDGE, which can be passed on to diabetics by competent diabetes educators and physicians. I know. I started in the DCCT in 1986 and the EDIC since 1993. And as we diabetics in this study continued to be followed it is knowledge that is gained. I agree with you, people need supplies. The sad part is is that 16 years after the end of the DCCT, so many type one diabetics are ignorant about intensive therapy, which could save them so much grief.

Posted by Jerry1423 on 5 September 2009

There seems to be two groups in this study: one group had intensive control (A1C of 6%) and a group of looser control (A1C range not specified). I assume most of us (type 1 diabetics) fall into a group somewhere between those two groups. I will ever get down to a 6% A1C, but I am under decent control - after 34 years I have no complications. I don't like how this study was conducted at all.

Posted by Anonymous on 6 September 2009

As a diabetic type 1 of 60 years when on pig insulin a few years ago it was easy for good control but since going on mixtard my control is very difcult,I was very fit as I swan a lot ,cycled,prataced judo,martial arts did not smohe drank very little,but now have eye problms had a stroke and I think this is useful research

Posted by Rick on 6 September 2009

my intent was not to discourage people from controlling their bg. on the contrary. to cjensen61 i will say this. i have had type 1 for 43 years and have several complications, the worst being visual impairment. i can tell you that virtually all of my complications came before the advent of bg meters and pumps. since i've had these advantages i've been ok. if you make use of these advantages you will live a long, normal life. but don't die needlessly from insulin shock trying to get to a certain a1c. it can be very dangerous. the ada recommends an a1c of below 7%. not 6 and certainly not 5. test often, use all available tools at your disposal, get plenty of exercise, stay safe and you'll be fine. stay healthy and God bless you.

Posted by Anonymous on 6 September 2009

Tighter control is definitely advantageous ... to a point. Endangering yourself from hypoglycemic episodes is no way to live which is very common in very tight control. Living on that edge is not worth an A1C of 6 or lower. I am a type 1 diabetic of 33 year with no complications. A 7 A1C is best for me. I test regularly, use an insulin pump and continious glucose monitor, exercise, eat right and enjoy life. Lastly, keep those appts. with your docs and pay attention/address anything that isn't adding up ... prevention. That, for me, is my key to good health.

Posted by Anonymous on 6 September 2009

Let me get this straight. According to this study, getting you blood glucose levels as close to non-diabetic ranges as possible was found to be beneficial for diabetics?
Really?
Who would have thought?
Thanks NIH for clearing this up for us.

Our tax dollars at work.

Posted by Jerry Smith on 6 September 2009

I have had Type I diabetes since 1966. I am now 70 and live alone since my wife passed away last June. I had recent A1cs as low as 5.8%. However I also had a severe hypoglycemia event while trying to help my wife when she had difficulty breathing.

The bottom line is that I have been advised to back off a little. I now try to achieve an overnight BG goal of about 150. My last two A1cs were 6.4% and 6.6%. My BGs have settled down after all the recent stress.

The advice I have received is that severe hypoglycemia is a bigger risk for me than diabetes complications given my age and circumstances.

Posted by Rick on 7 September 2009

if anyone has had a severe low blood sugar where you don't know where you're at you know how scary it can be. jerry smiths blood sugars are perfect. one thing i refuse to do is die in my sleep in insulin shock after dealing with this for 43 years. a bg of 150 at bedtime is great. don't take chances with your life. and whoever told jerry that low bgs are a bigger threat to him at this point than complications is exactly right. hypoglycimia is probably the most dangerous complication of all. don't try to get normal bgs because we're not normal. and it could kill you.


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