The results of the DCCT (Diabetes Control and Complications Trial) were announced on June 13, 1993, in a two-hour session at the Annual Meeting of the American Diabetes Association,
and published
in the New England Journal of Medicine,
329(14), September 30, 1993.
(The original article is entitled The Effect of Intensive Treatment of
Diabetes on the Development and
Progression of Long-Term Complications in Insulin-Dependent Diabetes
Mellitus.
An abstract of the article is available on the Internet, at
PubMed.)
This major scientific study was designed to answer the question whether "tight control" of blood sugar levels will prevent diabetes complications.
Design of the Study
The DCCT study included 1441 teenagers and young adults with type 1 diabetes,
who were randomly assigned to different groups:
conventional care (with urine or
blood sugar tests, one or two insulin injections daily,
and
"routine"
three month follow-up visits),
or intensive treatment,
which included initial hospitalization for education and stabilization,
four or more blood sugar tests daily,
use of either an
insulin pump,
or multiple daily insulin injections, monthly office visits, and frequent (sometimes daily) telephone calls between the patients
and the DCCT's diabetes nurse educators.
Patients were enrolled over several years,
with the range of participation of about three to nine years. During the ten years of the study, there was only an extremely low dropout rate of only 1%.
Some Preliminary Results Were Previously Reported
Several preliminary results of the DCCT have already been published:
there is a three-fold increase in the risk of severe hypoglycemic episodes in the intensive care group;
also, the overall average
glycohemoglobin level
of the intensive care group remained about 1 point above the upper edge of the normal range — despite all the effort involved.
Final Results: Decreased Rate of Complications
The results of the DCCT study show an overwhelming difference
in the chances of developing three major diabetic microvascular complications:
there was a
sixty-two percent reduction in relative risk of
diabetic retinopathy
(eye disease),
fifty-six percent less progression of
kidney disease,
and
sixty percent less progression of neuropathy
(nerve damage), in the intensively-treated group of patients.
All these decreases in risk were seen in all subgroups, male/female, teenage/young adult, and recent/remote onset of diabetes. The differences between the intensive and conventional groups were apparent within three years, and the curves showing the rate of developing complications of the two groups progressively diverged as the years went by. There was no increase for the intensive group in deaths, behavioral changes, or other adverse outcomes, with the exception of the increased frequency of hypoglycemia, and somewhat greater increase in weight gain in patients in the intensive group.
Comments
Although the DCCT only included Type 1 patients, it is the intent of the American Diabetes Association to tell every patient with diabetes about the DCCT results, and offer everyone the opportunity to start a "tight control" diabetes program to prevent complications. It's also clear from the DCCT that any reduction in glycohemoglobin will decrease the risks of microvascular complications somewhat, and that efforts to this end would be advantageous for every patient to implement. The impact of these results will forever change diabetes care: we now know that diabetic complications can be delayed or prevented.
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Also see
The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus..(Abstract of the article, at PubMed.)
Diabetes
Control and Complications Trial
from the National Institute of Diabetes and Digestive and Kidney Disease/NIH
Research:
The Diabetes Control and Complications Trial
at the DIABETES REGISTRY
UK Prospective Diabetes Study
(A study showing lessened complications in type 2 diabetes when tight control is implemented.)
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