研究

DCCT (NEJM 1993)
UKPDS

DCCT:
Results of Type 1 Diabetes Clinical Trial

Known as the Diabetes Control and Complications Trial (DCCT), this landmark trial showed the importance of intensive blood glucose in controlling blood glucose and reducing the development of complications in type 1 diabetes.

The DCCT – which included more than 1,400 participants — demonstrated that intensive therapy was better than the conventional therapy used at that time. Conventional therapy relied on one or two fixed doses of insulin that did not vary with meals.

The intensively managed participants maintained average blood glucose values of about 150 mg/dl. Better yet, the DCCT also demonstrated that maintaining an HbA1c value of around 7% reduced the risk of long-term eye, kidney and nerve complications by approximately 60%:

A follow-up of DCCT participants further showed that a period of sustained glucose control helps to protect against long term eye, kidney and nerve complications as well as heart disease or atherosclerosis – even many years later. These benefits occurred despite less intensive blood sugar control after the DCCT study ended.



UKPDS:

The UKPDS showed that long-term complications of type 2 diabetes can be prevented through intensive blood glucose and blood pressure management: The UKPDS included almost 4,000 people with newly diagnosed type 2 diabetes.

The study demonstrated that:

 -Type 2 diabetes is progressive over time, and as the pancreas loses its ability to make insulin, more treatment is required
 -High blood glucose and high blood pressure both play an important role in the development of diabetes complications.
 -Intensive blood glucose control & management of hypertension resulted in fewer diabetes related complications, and approximately:

   20% decrease in death related to diabetes
   40% decrease in eye, kidney, and nerve diabetes complications
   40% decrease in blockage of the blood vessels to the lower limbs
   15% decrease in heart attack

For every 10 mmHG drop in the systolic blood pressure, there was an approximate 12% decrease in:

   Death related to diabetes
   Eye, kidney, and nerve diabetes complications
   Heart attack