Beneficial effects of intensive therapy of diabetes during adolescence: Outcomes after the conclusion of the Diabetes Control and Complications Trial (DCCT)
Beneficial effects of intensive therapy of diabetes during adolescence: Outcomes after the conclusion of the Diabetes Control and Complications Trial (DCCT)
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DOI：
10.1067/mpd.2001.118887
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发表时间：
2001-12-01
影响因子：
5.1
通讯作者：
Sibley, S
中科院分区：
文献类型：
--
作者：
Genuth, S;Nathan, D;Sibley, S
目的：糖尿病控制和并发症试验(DCCT)表明，强化治疗I型糖尿病可降低发生和进展微血管并发症的风险。糖尿病干预和并发症流行病学(EDIC)研究评估了这些益处在DCCT结束后是否持续。研究设计：在DCCT青少年队列中(n=195)，175人参加了EDIC，151人做了眼底照相，156人在3岁或4岁测量了白蛋白排泄率。分析了从DCCT关闭到ED IC 4年的视网膜病变和蛋白尿的进展几率。结果：与DCCT期间平均血红蛋白A的7.4年相比，强化治疗的水平显著低于常规治疗(8.06%对9.76%；P<；0001)，随后的前4年EDIC的平均血红蛋白Alc水平在前强化组和前常规组之间相似(8.38%对8.45%)。然而，与常规治疗组相比，强化治疗组视网膜病变恶化3步或以上以及进展为增殖性或严重非增殖性视网膜病变的发生率分别降低了74%(P<；.001)和78%(P<；.007)。结论：这些发现进一步支持了DCCT的建议，即大多数青少年I型糖尿病患者接受强化治疗，旨在尽可能接近正常的血糖控制，以降低微血管并发症的风险。
Objective: The Diabetes Control and Complications Trial (DCCT) demonstrated that intensive therapy of type I diabetes mellitus reduces the risk of development and progression of microvascular complications. The Epidemiology, of Diabetes Interventions and Complications (EDIC) study assessed whether these benefits persisted after the end of DCCT. Results for the adolescent DCCT cohort are reported here.Study design: Of the DCCT adolescent cohort (n = 195), 175 participated in EDIC, 151 had fundus photography, and 156 had albumin excretion rate measured at year 3 or 4. The odds of progression of retinopathy and albuminuria from closeout of the DCCT until ED IC year 4 were assessed.Results: In contrast to the 7.4 years of the DCCT during which mean hemoglobin A,, levels were significantly lower with intensive therapy than conventional therapy (8.06% vs 9.76%; P < .0001), the subsequent first 4 years of EDIC had mean hemoglobin Alc levels that were similar between the former intensive and the former conventional groups (8.38% vs 8.45%). However, the prevalence of worsening of 3 steps or more in retinopathy and of progression to proliferative or severe nonproliferative retinopathy were reduced by 74% (P < .001) and 78% (P < .007), respectively, in the former intensive therapy group compared with the Former conventional group.Conclusions: These findings provide further support for the DCCT recommendation that most adolescents with type I diabetes receive intensive therapy aimed at achieving glycemic control as close to normal as possible to reduce the risk of microvascular complications.