Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study at 30 Years: Advances and Contributions
David M. Nathan,Margaret L. Bayless,Patricia A. Cleary,Saul Genuth,Rose Gubitosi-Klug,John M. Lachin,Gayle M. Lorenzi,Bernard Zinman +7 more
TLDR
An overview of the major scientific advances provided by the DCCT/EDIC Research Group, the resulting changes in therapy that have improved long-term outcomes in patients with T1D worldwide, and the challenges that remain are presented.Abstract:
The Diabetes Control and Complications Trial (DCCT) (1) and its observational follow-up, the Epidemiology of Diabetes Interventions and Complications (EDIC) Study (2), are celebrating the 30th anniversary since the start of the DCCT and 20th since the reporting of the DCCT primary results (3). During the past three decades, our understanding of the relationship between metabolic control and complications and the treatment of type 1 diabetes (T1D) has been transformed by the results of DCCT/EDIC. Most importantly, the long-term prospects for patients have dramatically improved with the adoption of intensive therapy designed to achieve near-normal glycemia as the standard of care of T1D. In this Perspective, we present an overview of the major scientific advances provided by the DCCT/EDIC Research Group, the resulting changes in therapy that have improved long-term outcomes in patients with T1D worldwide, and the challenges that remain.
### Background and rationale.
After the introduction of insulin therapy in 1922, type 1 diabetes (T1D) was transformed from a uniformly fatal disease to a chronic degenerative one (4). During the 1930–1960s, the development of chronic complications affecting the eyes, kidneys, peripheral and autonomic nervous system, and a substantially increased risk of cardiovascular disease (CVD) were observed in patients who had survived >20 years with the disease (5). The origin of these newly discovered complications was debated vigorously, and theories to explain them abounded (4,6). The debate led to two opposing philosophies of diabetes treatment: one in which treatment to achieve glucose concentrations as low as possible was endorsed and another in which glycemic levels were thought to be inconsequential, at least with regard to the pathogenesis of long-term complications (7,8). Although the debate regarding the so-called glucose hypothesis was vigorous, it was largely academic, since objective means of measuring long-term glycemia and of achieving near-normal glycemia did not …read more
Citations
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2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD
Francesco Cosentino,Peter J. Grant,Victor Aboyans,Clifford J Bailey,Antonio Ceriello,Victoria Delgado,Massimo Federici,Gerasimos Filippatos,Diederick E. Grobbee,Tina Birgitte Hansen,Heikki V. Huikuri,I. Johansson,Peter Jüni,Maddalena Lettino,Nikolaus Marx,Linda Mellbin,Carl J. Östgren,Bianca Rocca,Marco Roffi,Naveed Sattar,Petar M. Seferović,Miguel Sousa-Uva,Paul Valensi,David C Wheeler +23 more
TL;DR: The second iteration of the European Society of Cardiology (ESC) and European Association for the Study of Diabetes (EASD) joining forces to write guidelines on the management of diabetes mellitus (DM), pre-diabetes, and cardiovascular disease (CVD), designed to assist clinicians and other healthcare workers to make evidence-based management decisions.
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Molecular mechanisms of diabetic kidney disease
TL;DR: Tight glucose control significantly decreases DKD incidence, indicating that hyperglycemia-induced metabolic alterations, including changes in energy utilization and mitochondrial dysfunction, play critical roles in disease initiation.
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Association between 7 years of intensive treatment of type 1 diabetes and long-term mortality.
Trevor J. Orchard,David M. Nathan,Bernard Zinman,Patricia A. Cleary,David J. Brillon,Jye-Yu C. Backlund,John M. Lachin +6 more
TL;DR: After a mean of 27 years' follow-up of patients with type 1 diabetes, 6.5 years of initial intensive diabetes therapy was associated with a modestly lower all-cause mortality rate when compared with conventional therapy.
Journal ArticleDOI
Diabetes: Advances in Diagnosis and Treatment
TL;DR: Improved glycemic control and better management of other identified risk factors for the complications of diabetes and more effective treatment of cardiovascular disease and microvascular complications have resulted in a more optimistic outlook for people with diabetes.
References
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Journal ArticleDOI
The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus.
Diabetes Control,David M. Nathan,Saul M. Genuth,John M. Lachin,Patricia A. Cleary,O Crofford,Matthew M. Davis,Larry Rand,Carolyn Siebert +8 more
TL;DR: Intensive therapy effectively delays the onset and slows the progression of diabetic retinopathy, nephropathy, and neuropathy in patients with IDDM.
Journal ArticleDOI
Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes.
David M. Nathan,Patricia A. Cleary,Jye Yu C. Backlund,Saul Genuth,John M. Lachin,Trevor J. Orchard,Philip Raskin,Bernard Zinman +7 more
TL;DR: Intensive diabetes therapy has long-term beneficial effects on the risk of cardiovascular disease in patients with type 1 diabetes, and changes between treatment groups remained significant after adjusting for these factors.
Journal ArticleDOI
Glucagon-like peptide-1 7-36: a physiological incretin in man.
TL;DR: The observation of greatly increased postprandial plasma GLP-1 7-36 levels in patients with postgastrectomy dumping syndrome suggests that it may mediate the hyperinsulinaemia and reactive hypoglycaemia of this disorder.
Journal ArticleDOI
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☆☆☆★★★
TL;DR: It is concluded 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.
Journal ArticleDOI
Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy.
Diabetes Control,Complications Trial,John M. Lachin,Saul Genuth,Patricia A. Cleary,Matthew D. Davis,David M. Nathan +6 more
TL;DR: The reduction in the risk of progressive retinopathy and nephropathy resulting from intensive therapy in patients with type 1 diabetes persists for at least four years, despite increasing hyperglycemia.
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Anushka Patel,Stephen MacMahon,John Chalmers,Bruce Neal,Laurent Billot,Mark Woodward,Mark Woodward,Michel Marre,Mark E. Cooper,Paul Glasziou,Paul Glasziou,Diederick E. Grobbee,Pavel Hamet,Stephen B. Harrap,Simon Heller,Lisheng Liu,Giuseppe Mancia,Carl Erik Mogensen,C. Y. Pan,Neil R Poulter,Anthony Rodgers,Bryan Williams,Severine Bompoint,Bastiaan E. de Galan,Bastiaan E. de Galan,Rohina Joshi,F. Travert +26 more