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
TLDR
Intensive therapy effectively delays the onset and slows the progression of diabetic retinopathy, nephropathy, and neuropathy in patients with IDDM.Abstract:
Background Long-term microvascular and neurologic complications cause major morbidity and mortality in patients with insulin-dependent diabetes mellitus (IDDM). We examined whether intensive treatment with the goal of maintaining blood glucose concentrations close to the normal range could decrease the frequency and severity of these complications. Methods A total of 1441 patients with IDDM--726 with no retinopathy at base line (the primary-prevention cohort) and 715 with mild retinopathy (the secondary-intervention cohort) were randomly assigned to intensive therapy administered either with an external insulin pump or by three or more daily insulin injections and guided by frequent blood glucose monitoring or to conventional therapy with one or two daily insulin injections. The patients were followed for a mean of 6.5 years, and the appearance and progression of retinopathy and other complications were assessed regularly. Results In the primary-prevention cohort, intensive therapy reduced the adjusted mean risk for the development of retinopathy by 76 percent (95 percent confidence interval, 62 to 85 percent), as compared with conventional therapy. In the secondary-intervention cohort, intensive therapy slowed the progression of retinopathy by 54 percent (95 percent confidence interval, 39 to 66 percent) and reduced the development of proliferative or severe nonproliferative retinopathy by 47 percent (95 percent confidence interval, 14 to 67 percent). In the two cohorts combined, intensive therapy reduced the occurrence of microalbuminuria (urinary albumin excretion of > or = 40 mg per 24 hours) by 39 percent (95 percent confidence interval, 21 to 52 percent), that of albuminuria (urinary albumin excretion of > or = 300 mg per 24 hours) by 54 percent (95 percent confidence interval 19 to 74 percent), and that of clinical neuropathy by 60 percent (95 percent confidence interval, 38 to 74 percent). The chief adverse event associated with intensive therapy was a two-to-threefold increase in severe hypoglycemia. Conclusions Intensive therapy effectively delays the onset and slows the progression of diabetic retinopathy, nephropathy, and neuropathy in patients with IDDM.read more
Citations
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Journal ArticleDOI
Severe hypoglycaemia in 1076 adult patients with type 1 diabetes: influence of risk markers and selection.
Ulrik Pedersen-Bjergaard,Stig Pramming,Simon Heller,Tara M Wallace,Åse K Rasmussen,Hanne V. Jørgensen,David R. Matthews,Philip Hougaard,Birger Thorsteinsson +8 more
TL;DR: The purpose of this study was to assess the frequency of severe hypoglycaemia in unselected patients treated in different secondary care centres and to evaluate the influence of risk markers, clinical setting and selection.
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Poor prognosis of young adults with type 1 diabetes: a longitudinal study.
TL;DR: Diabetes symptoms in later adolescence and young adulthood appeared to predict later psychiatric problems, and the clinical and psychiatric outcome in this cohort was poor.
Journal ArticleDOI
Hyperglycemia Regulates Hypoxia-Inducible Factor-1α Protein Stability and Function
TL;DR: It is demonstrated that in primary dermal fibroblasts and endothelial cells, hyperglycemia interferes with the function of hypoxia-inducible factor-1 (HIF-1), a transcription factor that is essential for adaptive responses of the cell to Hypoxia.
Journal ArticleDOI
Disparities in HbA1c Levels Between African-American and Non-Hispanic White Adults With Diabetes: A meta-analysis
Julienne K. Kirk,Ralph B. D'Agostino,Ronny A. Bell,Leah Passmore,Denise E. Bonds,Andrew J. Karter,K.M. Venkat Narayan +6 more
TL;DR: In this paper, a comparison of HbA 1c (A1C) levels between African Americans and non-Hispanic whites was evaluated, and a meta-analysis revealed the standard effect to be 0.31 (95% CI 0.39-0.25).
Journal ArticleDOI
Health Disparities in Endocrine Disorders: Biological, Clinical, and Nonclinical Factors—An Endocrine Society Scientific Statement
Sherita Hill Golden,Arleen F. Brown,Jane A. Cauley,Marshall H. Chin,Tiffany L. Gary-Webb,Catherine Kim,Julie Ann Sosa,Anne E. Sumner,Blair Anton +8 more
TL;DR: Several themes emerged in the statement, including a need for basic science, population-based, translational and health services studies to explore underlying mechanisms contributing to endocrine health disparities, suggesting that population interventions targeting weight loss may favorably impact a number of endocrine disorders.
References
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Journal ArticleDOI
The Wisconsin Epidemiologic Study of Diabetic Retinopathy: II. Prevalence and Risk of Diabetic Retinopathy When Age at Diagnosis Is Less Than 30 Years
TL;DR: In a population-based study in southern Wisconsin, 996 insulin-taking, younger-onset diabetic persons were examined using standard protocols to determine the prevalence and severity of diabetic retinopathy and associated risk variables.
Journal ArticleDOI
The Wisconsin epidemiologic study of diabetic retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years.
TL;DR: The severity of retinopathy was found to be related to longer duration of diabetes, younger age at diagnosis, higher glycosylated hemoglobin levels, higher systolic BP, use of insulin, presence of proteinuria, and small body mass.
Journal ArticleDOI
The effect of long-term intensified insulin treatment on the development of microvascular complications of diabetes mellitus.
TL;DR: Long-term intensified insulin treatment, as compared with standard treatment, retards the development of microvascular complications in patients with insulin-dependent diabetes mellitus.
Journal ArticleDOI
Effect of two years of strict metabolic control on progression of incipient nephropathy in insulin-dependent diabetes
TL;DR: 36 patients with insulin-dependent diabetes mellitus who had 'Albustix'-negative urine but raised urinary albumin excretion were randomly assigned to either remaining on conventional insulin treatment or continuous subcutaneous insulin infusion and followed up for 2 years.
Journal ArticleDOI
Prognosis of diabetics with diabetes onset before the age of thirty-one. I. Survival, causes of death, and complications
TL;DR: Clinical manifestations of late diabetic complications were considerably less common in patients who were still alive after more than forty years of diabetes than in Patients who died before their fortieth year of diabetes.
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