NationMaster - Encyclopedia: Diabetes control and complications trial

The Diabetes Control and Complications Trial, or DCCT was the largest, most comprehensive diabetes study ever conducted at the time. For the disease characterized by excretion of large amounts of severely diluted urine, see diabetes insipidus. ...

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) conducted this clinical study of 1441 volunteers with Type 1 diabetes at 29 medical centers in the US and Canada between 1983 and 1993.^[1] United States is the current Good Article Collaboration of the week! Please help to improve this article to the highest of standards. ...

A study in the UK known as the United Kingdom Prospective Diabetes Study (UKPDS), released in 1999, found similar results for Type 2 diabetics.^[2] Between the two studies, the treatment of diabetics was significantly changed.

1 Purpose of the study
2 Results of the DCCT
3 Significance of the DCCT
4 See also

Purpose of the study

Long-term microvascular and neurologic complications cause major morbidity and mortality in patients with diabetes. This study examined whether intensive treatment with the goal of maintaining blood glucose concentrations close to the normal range could decrease the frequency and severity of those complications. Microvascular disease is a disease of any small blood vessels in the body. ... Neurology is a branch of medicine dealing with disorders of the nervous system. ... Several fields refer to compliations: Complication (medicine) - a unfavorable evolution of a disease, a health condition or a medical treatment Complication (horology) - a special feature in a mechanical clock that causes the design of the movement to become more complicated This is a disambiguation page, a list of pages that... In medicine, epidemiology and actuarial science, the term morbidity can refer to the state of being diseased (from Latin morbidus: sick, unhealthy), the degree or severity of a disease, the prevalence of a disease: the total number of cases in a particular population at a particular point in time, the... In medicine, blood sugar is glucose in the blood. ...

A total of 1441 volunteers at 29 medical centers in the US and Canada were randomly assigned to receive standard therapy or intensive control therapy. All 1441 volunteers had Type 1 diabetes (then known as Insulin-Dependent Diabetes Mellitus or IDDM in the medical community, and "juvenile diabetes" in the general population). People with Type 2 diabetes (then known as Non-Insulin-Dependent Diabetes Mellitus or NIDDM in the medical community, and "sugar diabetes" or "adult-onset" diabetes in the general population) were excluded from the study, as were patients who had been diagnosed less than a year before, or more than fifteen years before. Medical Center was a drama that ran on CBS from 1969 to 1976. ... United States is the current Good Article Collaboration of the week! Please help to improve this article to the highest of standards. ...

Of those studied, 726 had no retinopathy at the beginning of the trial, and 715 had limited retinopathy. Those with greater degrees of retinopathy were excluded from the trial. Diabetic retinopathy is retinopathy (damage to the retina) caused by complications of diabetes mellitus, which could eventually lead to blindness. ...

The volunteers were randomly assigned to one of two groups. The conventional diabetes therapy group received one or two daily insulin injections. The intensive therapy group frequently monitored blood glucose levels, and received at least three daily insulin injections; some wore an external pump. It has been suggested that Oral insulin be merged into this article or section. ... An insulin pump is a device used for administering insulin in the treatment of diabetes mellitus. ...

Patients in the study were followed for 6.5 years on average. The appearance and progression of retinopathy and certain other complications were regularly assessed. In mathematics and statistics, the arithmetic mean (or simply the mean) of a list of numbers is the sum of all the members of the list divided by the number of items in the list. ...

Results of the DCCT

Retinopathy

Among those volunteers who previously had exhibited no retinopathy, intensive control therapy reduced the adjusted mean risk by 76%.
Among those who had mild retinopathy, intensive control therapy slowed the progression of retinopathy by 54%, and reduced the development of severe nonproliferative retinopathy by 47%.

Albuminuria

Intensive control therapy reduced microalbuminuria (40 mg/day) by 39%.
Intensive control therapy reduced albuminuria (300 mg/day) by 54%.

Microalbuminuria - the measurement of small amounts of albumin in the urine that cannot be detected by urine dipstick methods. ... Albuminuria is a pathological condition where albumin is present in the urine. ...

Neuropathy

Clinical neuropathy was reduced 60% with intensive control treatment.
Intensive control therapy reduced abnormal nerve conduction by 44%
Intensive control therapy reduced abnormal autonomic nervous system function by 53%
Nerve conduction velocities remained stable with intensive control therapy, decreased with conventional therapy

Neuropathy, strictly speaking, is any disease that affects the nervous system. ... A nerve conduction study (NCS) is a test commonly used to evaluate the function, especially the ability of electrical conduction, of the motor and sensory nerves of the human body. ... This article or section is in need of attention from an expert on the subject. ...

Severe Hypoglycemia

The chief adverse event associated with intensive therapy was a 200-300% increase in severe hypoglycemia.

Hypoglycemia (hypoglycÃ¦mia in the UK) is a medical term referring to a pathologic state produced by a lower than normal amount of sugar (glucose) in the blood. ...

Significance of the DCCT

The authors of the study featured the benefits of close control - clearly reduced eye, kidney and nerve damage - in their conclusion,^[3] but did not note that they were unable to show any reduction in cardiovascular morbidity and mortality.^[4] This is important because people with diabetes are 2-4 times more likely to have heart disease than persons without diabetes, and 75% of all diabetes-related deaths are from cardiovascular disease. ^[5]

Furthermore, although they observed a far greater increase in hypoglycemia than there was reduction in eye, kidney and nerve damage, they also failed to note that in their conclusions.

Despite the fact that the DCCT studied only Type 1 diabetics, and a restricted group of them at that, many clinicians began recommending tight control to both Type 1 and Type 2 diabetics. ^[6] Additionally, many medical centers started using a team approach to treating diabetics, consisting of a physician, nurse educator, dietitian, and behavioral therapist. The Doctor by Samuel Luke Fildes This article is about the term physician, a type of doctor; for other uses of the word doctor see Doctor (disambiguation). ... This article focuses on the education and regulation of nurses. ... Dietitians are experts in food and nutrition. ... Cognitive therapy or cognitive behavior therapy is a kind of psychotherapy used to treat depression, anxiety disorders, phobias, and other forms of mental disorder. ...

Contents

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