Effect of prior intensive insulin treatment during the Diabetes Control and Complications Trial (DCCT) on peripheral neuropathy in type 1 diabetes during the Epidemiology of Diabetes Interventions and Complications (EDIC) Study.
Effect of prior intensive insulin treatment during the Diabetes Control and Complications Trial (DCCT) on peripheral neuropathy in type 1 diabetes during the Epidemiology of Diabetes Interventions and Complications (EDIC) Study.
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DOI：
10.2337/dc09-1941
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发表时间：
2010-05
期刊：
影响因子：
16.2
通讯作者：
Diabetes Control and Complications Trial /Epidemiology of Diabetes Interventions and Complications Research Group
中科院分区：
文献类型：
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作者：
Albers JW;Herman WH;Pop-Busui R;Feldman EL;Martin CL;Cleary PA;Waberski BH;Lachin JM;Diabetes Control and Complications Trial /Epidemiology of Diabetes Interventions and Complications Research Group
在糖尿病控制和并发症试验（DCCT）结束后13-14年接受强化和常规治疗的1型糖尿病受试者中，评价既往强化胰岛素治疗与常规胰岛素治疗对神经病变的影响，在此期间，两组患者的A1 C水平相似。在糖尿病干预和并发症流行病学（EDIC）研究期间，由对603例既往强化治疗受试者和583例既往常规治疗受试者的治疗状态不知情的检查者重复DCCT期间进行的临床和神经传导研究（NCS）。临床神经病变定义为与远端多发性神经病变一致的症状、感觉体征或反射变化，并证实为涉及正中神经、腓神经和腓肠神经中两条或多条神经的NCS异常。DCCT结束后13-14年，神经病变的患病率在以前的强化治疗组中从9%增加到25%，在以前的常规治疗组中从17%增加到35%，但组间差异仍然显著（P < 0.001），神经病变的发生率在强化治疗组（22%）低于常规治疗组（28%）（P = 0.0125）。针对DCCT结束时的NCS结果差异进行调整的事件神经病变分析模型显示，随访期间与之前的强化治疗相关的风险并未显着降低（比值比1.17 [95%CI 0.84-1.63]）。然而，在几个NCS指标中观察到显著的持续治疗组效应。对总体血糖控制的纵向分析显示平均A1 C与神经病变的发病率和患病率之间存在显著相关性。DCCT关闭后，既往强化胰岛素治疗的获益持续了13-14年，并提供了既往强化治疗对神经病变的持久影响的证据。
To evaluate the impact of former intensive versus conventional insulin treatment on neuropathy in Diabetes Control and Complications Trial (DCCT) intensive and conventional treatment subjects with type 1 diabetes 13–14 years after DCCT closeout, during which time the two groups had achieved similar A1C levels. Clinical and nerve conduction studies (NCSs) performed during the DCCT were repeated during the Epidemiology of Diabetes Interventions and Complications (EDIC) study by examiners masked to treatment status on 603 former intensive and 583 former conventional treatment subjects. Clinical neuropathy was defined by symptoms, sensory signs, or reflex changes consistent with distal polyneuropathy and confirmed with NCS abnormalities involving two or more nerves among the median, peroneal, and sural nerves. The prevalence of neuropathy increased 13–14 years after DCCT closeout from 9 to 25% in former intensive and from 17 to 35% in former conventional treatment groups, but the difference between groups remained significant (P < 0.001), and the incidence of neuropathy remained lower among former intensive (22%) than former conventional (28%) treatment subjects (P = 0.0125). Analytic models of incident neuropathy that adjusted for differences in NCS results at DCCT closeout showed no significant risk reduction associated with former intensive treatment during follow-up (odds ratio 1.17 [95% CI 0.84–1.63]). However, a significant persistent treatment group effect was observed for several NCS measures. Longitudinal analyses of overall glycemic control showed a significant association between mean A1C and measures of incident and prevalent neuropathy. The benefits of former intensive insulin treatment persisted for 13–14 years after DCCT closeout and provide evidence of a durable effect of prior intensive treatment on neuropathy.
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