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
Hypoglycemia-Associated Autonomic Failure in Advanced Type 2 Diabetes
TL;DR: Because the glucagon response to falling plasma glucose levels is virtually absent and the glycemic thresholds for autonomic and symptomatic responses to hypoglycemia are shifted to lower glucose concentrations by recent antecedent hypglycemia, patients with advanced type 2 diabetes, like those with type 1 diabetes, are at risk for hypoglyCEmia-associated autonomic failure and the resultant vicious cycle of recurrent iatrogenic hypoglycesmia.
Journal ArticleDOI
Diabetic retinopathy and serum lipoprotein subclasses in the DCCT/EDIC cohort
Timothy J. Lyons,Alicia J. Jenkins,Deyi Zheng,Daniel T. Lackland,Daniel L. McGee,W. Timothy Garvey,W. Timothy Garvey,Richard L. Klein +7 more
TL;DR: The data are consistent with a role for dyslipoproteinemia involving lipoprotein subclasses in the pathogenesis of diabetic retinopathy, and NMR-LSP reveals new associations between serum lipoproteins and severity ofretinopathy in type 1 diabetes.
Journal ArticleDOI
Fully Integrated Artificial Pancreas in Type 1 Diabetes: Modular Closed-Loop Glucose Control Maintains Near Normoglycemia
Marc D. Breton,Anne Farret,Daniela Bruttomesso,Stacey M. Anderson,Lalo Magni,Stephen D. Patek,Chiara Dalla Man,Jerome Place,Susan Demartini,Simone Del Favero,Chiara Toffanin,Colleen Hughes-Karvetski,Eyal Dassau,Howard Zisser,Francis J. Doyle,Giuseppe De Nicolao,Angelo Avogaro,Claudio Cobelli,Eric Renard,Boris Kovatchev +19 more
TL;DR: In this article, the authors presented a modular concept for integrated closed-loop control (CLC) design, illustrated by clinical studies involving 11 adolescents and 27 adults at the Universities of Virginia, Padova, and Montpellier.
Journal ArticleDOI
Incidence and long-term cost of steroid-related side effects after renal transplantation.
TL;DR: The cumulative projected 10-year cost of all side effects for a 50-patient cohort was $265, 900, or $5,300 per transplant patient, providing a rationale for further investigation of steroid-sparing immunosuppression protocols.
Journal ArticleDOI
Diabetes and Advanced Glycoxidation End-Products
TL;DR: The incidence of diabetes, especially type 2 diabetes, is increasing at an alarming rate assuming epidemic proportions (1). Worldwide, 124 million people had diabetes by 1997, although an estimated 221 million people will have diabetes by the year 2010.
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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