The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus
- PMID: 8366922
- DOI: 10.1056/NEJM199309303291401
The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus
Abstract
Background: Long-term microvascular and neurologic complications cause major morbidity and mortality in patients with insulin-dependent diabetes mellitus (IDDM). We examined whether intensive treatment with the goal of maintaining blood glucose concentrations close to the normal range could decrease the frequency and severity of these complications.
Methods: A total of 1441 patients with IDDM--726 with no retinopathy at base line (the primary-prevention cohort) and 715 with mild retinopathy (the secondary-intervention cohort) were randomly assigned to intensive therapy administered either with an external insulin pump or by three or more daily insulin injections and guided by frequent blood glucose monitoring or to conventional therapy with one or two daily insulin injections. The patients were followed for a mean of 6.5 years, and the appearance and progression of retinopathy and other complications were assessed regularly.
Results: In the primary-prevention cohort, intensive therapy reduced the adjusted mean risk for the development of retinopathy by 76 percent (95 percent confidence interval, 62 to 85 percent), as compared with conventional therapy. In the secondary-intervention cohort, intensive therapy slowed the progression of retinopathy by 54 percent (95 percent confidence interval, 39 to 66 percent) and reduced the development of proliferative or severe nonproliferative retinopathy by 47 percent (95 percent confidence interval, 14 to 67 percent). In the two cohorts combined, intensive therapy reduced the occurrence of microalbuminuria (urinary albumin excretion of > or = 40 mg per 24 hours) by 39 percent (95 percent confidence interval, 21 to 52 percent), that of albuminuria (urinary albumin excretion of > or = 300 mg per 24 hours) by 54 percent (95 percent confidence interval 19 to 74 percent), and that of clinical neuropathy by 60 percent (95 percent confidence interval, 38 to 74 percent). The chief adverse event associated with intensive therapy was a two-to-threefold increase in severe hypoglycemia.
Conclusions: Intensive therapy effectively delays the onset and slows the progression of diabetic retinopathy, nephropathy, and neuropathy in patients with IDDM.
Comment in
- ACP J Club. 1994 Mar-Apr;120 Suppl 2:30-1
-
The effect of intensive treatment of diabetes mellitus.N Engl J Med. 1994 Mar 3;330(9):641; author reply 642. doi: 10.1056/NEJM199403033300914. N Engl J Med. 1994. PMID: 8302352 No abstract available.
-
The effect of intensive treatment of diabetes mellitus.N Engl J Med. 1994 Mar 3;330(9):641-2. N Engl J Med. 1994. PMID: 8302353 No abstract available.
-
The effect of intensive treatment of diabetes mellitus.N Engl J Med. 1994 Mar 3;330(9):642. doi: 10.1056/NEJM199403033300915. N Engl J Med. 1994. PMID: 8302354 No abstract available.
-
The diabetes control and complications trial. Implications for policy and practice.N Engl J Med. 1993 Sep 30;329(14):1035-6. doi: 10.1056/NEJM199309303291410. N Engl J Med. 1993. PMID: 8366905 No abstract available.
-
Intensive diabetes treatment and cardiovascular disease.N Engl J Med. 2006 Apr 20;354(16):1751-2; author reply 1751-2. doi: 10.1056/NEJMc060105. N Engl J Med. 2006. PMID: 16625015 No abstract available.
Similar articles
-
Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial. Diabetes Control and Complications Trial Research Group.J Pediatr. 1994 Aug;125(2):177-88. doi: 10.1016/s0022-3476(94)70190-3. J Pediatr. 1994. PMID: 8040759 Clinical Trial.
-
The effect of long-term intensified insulin treatment on the development of microvascular complications of diabetes mellitus.N Engl J Med. 1993 Jul 29;329(5):304-9. doi: 10.1056/NEJM199307293290502. N Engl J Med. 1993. PMID: 8147960 Clinical Trial.
-
Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study.Diabetes Res Clin Pract. 1995 May;28(2):103-17. doi: 10.1016/0168-8227(95)01064-k. Diabetes Res Clin Pract. 1995. PMID: 7587918 Clinical Trial.
-
Insights from the diabetes control and complications trial/epidemiology of diabetes interventions and complications study on the use of intensive glycemic treatment to reduce the risk of complications of type 1 diabetes.Endocr Pract. 2006 Jan-Feb;12 Suppl 1:34-41. doi: 10.4158/EP.12.S1.34. Endocr Pract. 2006. PMID: 16627378 Review.
-
Diabetes control and complications.Annu Rev Med. 1995;46:267-79. doi: 10.1146/annurev.med.46.1.267. Annu Rev Med. 1995. PMID: 7598463 Review.
Cited by
-
Effectiveness of the flash glucose monitoring system in preventing severe hypoglycemic episodes and in improving glucose metrics and quality of life in subjects with type 1 diabetes at high risk of acute diabetes complications.Acta Diabetol. 2024 Jun 4. doi: 10.1007/s00592-024-02298-x. Online ahead of print. Acta Diabetol. 2024. PMID: 38833007
-
Within and post-trial effects of an intensive lifestyle intervention on kidney disease in adults with overweight or obesity and type 2 diabetes mellitus: a secondary analysis of the Look AHEAD clinical trial.BMJ Open Diabetes Res Care. 2024 May 30;12(3):e004079. doi: 10.1136/bmjdrc-2024-004079. BMJ Open Diabetes Res Care. 2024. PMID: 38816203 Free PMC article. Clinical Trial.
-
Analytical performance evaluation of the Mindray enzymatic assay for hemoglobin A1c measurement.Sci Rep. 2024 May 29;14(1):12289. doi: 10.1038/s41598-024-63261-y. Sci Rep. 2024. PMID: 38811684 Free PMC article.
-
Non-coronary arterial outcomes in people with type 1 diabetes mellitus: a Swedish retrospective cohort study.Lancet Reg Health Eur. 2024 Feb 15;39:100852. doi: 10.1016/j.lanepe.2024.100852. eCollection 2024 Apr. Lancet Reg Health Eur. 2024. PMID: 38803631 Free PMC article.
-
The association of chronic complications with time in tight range and time in range in people with type 1 diabetes: a retrospective cross-sectional real-world study.Diabetologia. 2024 May 24. doi: 10.1007/s00125-024-06171-y. Online ahead of print. Diabetologia. 2024. PMID: 38787436
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical