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
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Journal ArticleDOI
Outpatient insulin therapy in type 1 and type 2 diabetes mellitus: scientific review.
Dawn E. DeWitt,Irl B. Hirsch +1 more
TL;DR: Physiologic insulin therapy with insulin analogues is now relatively simple to use and is associated with fewer episodes of hypoglycemia, especially when started early in the course of disease.
Journal ArticleDOI
Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics
Margaret A. Powers,Joan K. Bardsley,Marjorie Cypress,Paulina Duker,Martha M. Funnell,Amy Hess Fischl,Melinda D. Maryniuk,Linda Siminerio,Eva M. Vivian +8 more
TL;DR: It is important for health care providers and their practice settings to have the resources and a systematic referral process to ensure that patients with type 2 diabetes receive both DSME and DSMS in a consistent manner.
Journal ArticleDOI
Management of hyperglycaemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy. A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes.
David M. Nathan,John B. Buse,Mayer B. Davidson,R.J. Heine,Rury R. Holman,R. Sherwin,Bernard Zinman +6 more
TL;DR: The role of intensive diabetes therapy on cardiovascular disease (CVD) complications in type 2 diabetes remains under active investigation as mentioned in this paper, and some therapies directed at lowering glucose levels have additional benefits with regard to CVD Diabetologia DOI 10.1007/s00125-006-0316-2
Journal ArticleDOI
Kv1.3 channels are a therapeutic target for T cell-mediated autoimmune diseases
Christine Beeton,Heike Wulff,Nathan Standifer,Philippe Azam,Katherine M. Mullen,Michael W. Pennington,Aaron Kolski-Andreaco,Eric Wei,Alexandra Grino,Debra Counts,Ping H. Wang,Christine J. LeeHealey,Brian S. Andrews,Ananthakrishnan Sankaranarayanan,Daniel Homerick,Werner W. Roeck,Jamshid Tehranzadeh,Kimber L. Stanhope,Pavel I. Zimin,Peter J. Havel,Stephen M Griffey,Hans Guenther Knaus,Gerald T. Nepom,George A. Gutman,Peter A. Calabresi,K. George Chandy +25 more
TL;DR: It is demonstrated that disease-associated autoreactive T cells from patients with type-1 diabetes mellitus or rheumatoid arthritis are mainly CD4+CCR7−CD45RA− effector memory T cells (TEM cells) with elevated Kv1.3 potassium channel expression, which ameliorate pristane-induced arthritis in rats and reduce the incidence of experimental autoimmune diabetes in diabetes-prone rats.
Journal ArticleDOI
Glycaemic control with continuous subcutaneous insulin infusion compared with intensive insulin injections in patients with type 1 diabetes: meta-analysis of randomised controlled trials
TL;DR: Glycaemic control is better during continuous subcutaneous insulin infusion compared with optimised injection therapy, and less insulin is needed to achieve this level of strict control.
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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