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
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
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DOI：
10.1016/s0022-3476(94)70190-3
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发表时间：
1994-08-01
影响因子：
5.1
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中科院分区：
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糖尿病控制和并发症试验表明，强化糖尿病治疗可延迟13 - 39是的胰岛素依赖型糖尿病受试者的糖尿病并发症发作并减缓其进展。我们在糖尿病控制和并发症试验中检查了这种治疗的效果是否在年轻糖尿病受试者（入组时年龄为13至17岁）的亚组中发生。125例基线时无视网膜病变的胰岛素依赖型糖尿病青少年受试者（一级预防队列）和70例轻度视网膜病变青少年受试者（二次干预队列）随机分配接受（1）外部胰岛素泵强化治疗或至少每日三次胰岛素注射，同时每日频繁监测血糖，或（2）常规治疗，每天注射一次或两次胰岛素，每天监测一次。受试者平均随访7.4年（4 - 9年）。在一级预防队列中，与常规治疗相比，强化治疗使视网膜病变的风险降低了53%（95%置信区间：1%至78%; p = 0.048）。在二次干预队列中，强化治疗使视网膜病变进展的风险降低70%（95%置信区间：25%-88%; p = 0.010），微量白蛋白尿的发生率降低55%（95%置信区间：3%-79%; p = 0.042）。运动和感觉神经传导速度在强化治疗的受试者中更快。强化治疗的主要不良事件是严重低血糖增加近3倍。我们的结论是，强化治疗有效地延迟了发病和减缓进展的糖尿病性视网膜病变和肾病时，开始在青少年受试者;的好处超过了低血糖的风险增加，伴随着这样的治疗。
The Diabetes Control and Complications Trial has demonstrated that intensive diabetes treatment delays the onset and slows the progression of diabetic complications in subjects with insulin-dependent diabetes mellitus from 13 to 39 yea rs of age. We examined whether the effects of such treatment a Iso occurred in the subset of young diabetic subjects (13 to 17 years of age at entry) in the Diabates Control and Complications Trial. One hundred twenty-five adolescent subjects with insulin-dependent diabetes mellitus but with no retinopathy at baseline (primary prevention cohort) and 70 adolescent subjects with mild retinopathy (secondary intervention cohort) were randomly assigned to receive either (1) intensive therapy with an external insulin pump or at least three daily insulin injections, together with frequent daily blood-glucose monitoring, or (2) conventional therapy with one or two daily insulin injections and once-daily monitoring. Subjects were followed for a mean of 7.4 years (4 to 9 years). In the primary prevention cohort, intensive therapy decreased the risk of having retinopathy by 53% (95% confidence interval: 1% to 78%; p = 0.048) in comparison with conventional therapy. In the secondary intervention cohort, intensive therapy decreased the risk of retinopathy progression by 70% (95% confidence interval: 25% to 88%; p = 0.010) and the occurrence of microalbuminuria by 55% (95% confidence interval: 3% to 79%; p = 0.042). Motor and sensory nerve conduction velocities were faster in intensively treated subjects. The major adverse event with intensive therapy was a nearly threefold increase of severe hypoglycemia. We conclude that intensive therapy effectively delays the onset and slows the progression of diabetic retinopathy and nephropathy when initiated in adolescent subjects; the benefits outweigh the increased risk of hypoglycemia that accompanies such treatment.