Tight glucose control cuts heart disease by half in type ...( ttack and stroke. The DCCT compar...),Health

The DCCT compared intensive management of blood glucose to conventional control in 1,441 people with type 1 diabetes. Patients 13 to 39 years of age took part in the trial between 1983 and 1989. At the time, conventional treatment consisted of one or two insulin injections a day with daily urine or blood glucose testing. Participants randomly assigned to intensive treatment were asked to keep glucose levels as close to normal as possible. That meant trying to keep hemoglobin A1c (HbA1c) readings at 6 percent or less with at least three insulin injections a day or an insulin pump, guided by frequent self-monitoring of blood glucose. (HbA1c reflects average blood glucose over the past 2 to 3 months.)

Researchers announced the DCCT's main results in 1993: intensive glucose control greatly lowers the eye, nerve, and kidney damage of type 1 diabetes. At the end of the study, HbA1c readings averaged 7 percent in the intensively treated group and 9 percent in the conventionally treated patients, who were then encouraged to adopt intensive control and shown how to do it. The DCCT findings prompted a major shift in the way doctors manage their patients with type 1 diabetes.

As researchers continued to follow participants, they saw that intensive treatment reduced the development of atherosclerosis, a finding published in 2003. They also observed a striking advantage of intensive control: its long-lasting effects. The benefits of the first 6 years of intensive control persisted even though the blood glucose level of the intensively treated group had gradually risen to a HbA1c reading of about 8 percent, matching that of the conventionally treated group, which had declined.

In results reported today, tight glucose control lowered the risk of a cardiovascular event by 42 percent and the risk of a serious event, including heart attack or stroke, by 58 percent. Among the 1,375 volunteers continuing to participate in
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Contact: Joan Chamberlain
niddkdkocpl@niddk.nih.gov
301-496-3583
NIH/National Institute of Diabetes and Digestive and Kidney Diseases
21-Dec-2005