Effect of intensive therapy on the microvascular complications of type 1 diabetes mellitus.
Effect of intensive therapy on the microvascular complications of type 1 diabetes mellitus.
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DOI：
10.1001/jama.287.19.2563
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发表时间：
2002-05
期刊：
影响因子：
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通讯作者：
S. Genuth;Janie Lipps;G. Lorenzi;D. Nathan;M. Davis;J. Lachin;P. Cleary
中科院分区：
文献类型：
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作者：
S. Genuth;Janie Lipps;G. Lorenzi;D. Nathan;M. Davis;J. Lachin;P. Cleary
本报告的目的是总结和整合糖尿病控制和并发症试验（DCCT）（一项随机对照临床试验）的结果，以及糖尿病干预和并发症流行病学（EDIC）研究中DCCT队列的后续观察性随访，关于强化治疗对1型糖尿病微血管并发症的影响。DCCT证明，与常规治疗相比，强化治疗可将视网膜病变、肾病和神经病变的风险降低35%至90%。视网膜病变和肾病的绝对风险与每次事件发生前随访期间的平均糖化血红蛋白（HbA（1c））水平成正比。在发现并发症之前尽早开始强化治疗是最有效的。这些风险降低，在常规治疗的中位HbA（1c）水平差异为9.1%与强化治疗的7.3%时实现，并在EDIC治疗7年后得以维持，尽管1年时2个先前随机化治疗组的平均HbA（1c）水平差异仅为0.4%（P<.001）（前常规治疗组为8.3%，前强化治疗组为7.9%），继续缩小，5年时变得无统计学意义（8.1% vs 8.2%，P =.09）。在前强化治疗组中，DCCT结束时并发症的进一步进展率仍然较低。因此，6.5年强化治疗的益处远远超出了其最密集的实施期。在1型糖尿病发病后，应在安全的情况下尽快开始强化治疗，并在此后维持治疗，目标是将HbA（1c）水平控制在7.0%或更低。
The purpose of this report is to summarize and integrate the findings of the Diabetes Control and Complications Trial (DCCT), a randomized controlled clinical trial, and the succeeding observational follow-up of the DCCT cohort in the Epidemiology of Diabetes Interventions and Complications (EDIC) study, regarding the effects of intensive treatment on the microvascular complications of type 1 diabetes mellitus. The DCCT proved that intensive treatment reduced the risks of retinopathy, nephropathy, and neuropathy by 35% to 90% compared with conventional treatment. The absolute risks of retinopathy and nephropathy were proportional to the mean glycosylated hemoglobin (HbA(1c)) level over the follow-up period preceding each event. Intensive treatment was most effective when begun early, before complications were detectable. These risk reductions, achieved at a median HbA(1c) level difference of 9.1% for conventional treatment vs 7.3% for intensive treatment have been maintained through 7 years of EDIC, even though the difference in mean HbA(1c) levels of the 2 former randomized treatment groups was only 0.4% at 1 year (P<.001) (8.3% in the former conventional treatment group vs 7.9% in the former intensive treatment group), continued to narrow, and became statistically nonsignificant by 5 years (8.1% vs 8.2%, P =.09). The further rate of progression of complications from their levels at the end of the DCCT remains less in the former intensive treatment group. Thus, the benefits of 6.5 years of intensive treatment extend well beyond the period of its most intensive implementation. Intensive treatment should be started as soon as is safely possible after the onset of type 1 diabetes mellitus and maintained thereafter, aiming for a practicable target HbA(1c) level of 7.0% or less.