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Intensive Glucose Control Halves Complications of Longstanding Type 1 Diabetes BETHESDA, Md -- July 28, 2009 -- Near-normal control of glucose beginning as soon as possible after diagnosis would greatly improve the long-term prognosis of type 1 diabetes, according to a study published in the July 27 issue of the Archives of Internal Medicine. The Diabetes Control and Complications Trial (DCCT), conducted from 1983 to 1989, found that intensive glucose control was superior to conventional control in delaying or preventing the complications of type 1 diabetes. Epidemiology of Diabetes Interventions and Complications (EDIC) continues to follow DCCT participants to determine the long-term effects of prior intensive versus conventional blood glucose control. The authors compared overall rates of eye, kidney, and cardiovascular complications in 3 groups of people diagnosed with type 1 diabetes an average of 30 years earlier. Two groups consisted of DCCT/EDIC participants -- those randomly assigned to intensive glucose control or to conventional control. The third group was a subset of patients in the Pittsburgh Epidemiology of Diabetes Complications (EDC) study, who were matched to DCCT/EDIC participants by age, duration of diabetes, and degree of eye damage. The EDC is a population-based study that has been following residents of Allegheny County, Pennsylvania, who were diagnosed with type 1 diabetes from 1950 to 1980. After 30 years of diabetes, DCCT participants randomly assigned to intensive glucose control had about half the rate of eye damage compared with those assigned to conventional glucose control (21% vs 50%). They also had lower rates of kidney damage (9% vs 25%) and cardiovascular disease events (9% vs 14%) compared with those receiving conventional glucose control. Eye damage ranged from significant damage without vision loss to blindness. Kidney damage ranged from mild kidney disease to kidney failure. Cardiovascular events encompassed myocardial infarction, angina, stroke, and obstruction of the coronary arteries. The intensively treated DCCT group also had lower complication rates than EDC participants, whose rates were similar to DCCT's conventional control group: eye damage (47%), kidney damage (17%), and cardiovascular disease events (14%). "Better treatment of blood pressure and cholesterol is also helping to reduce complication rates," said lead author of the EDC study Trevor Orchard, MD, University of Pittsburgh, Pittsburgh, Pennsylvania. The similar event rates in the DCCT conventional control group and the EDC study suggest that the results of the DCCT trial are likely to be generally applicable to those with type 1 diabetes." "These data give clinicians a realistic description of the clinical outcomes they can discuss with their patients," said David M. Nathan, MD, Massachusetts General Hospital, Boston, Massachusetts. "When intensive therapy, now the standard of care, is implemented early in the course of diabetes, most patients with type 1 diabetes should be able to avoid the disastrous long-term complications that were so common in the past." SOURCE: National Institutes of Health E-mail this page to a friend or colleague! To print, use this version