The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long‐Term Complications in Insulin‐Dependent Diabetes Mellitus

  title={The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long‐Term Complications in Insulin‐Dependent Diabetes Mellitus},
  author={David M Nathan and Saul M. Genuth and John M. Lachin and Patricia A. Cleary and O. Crofford and Matthew Davis and Lawrence I Rand and Carolyn Siebert},
  journal={Survey of Anesthesiology},
BACKGROUND Long-term microvascular and neurologic complications cause major morbidity and mortality in patients with insulin-dependent diabetes mellitus (IDDM. [] Key MethodMETHODS 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…

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Effect of intensive therapy on the microvascular complications of type 1 diabetes mellitus.

The DCCT proved that intensive treatment reduced the risks of retinopathy, nephropathy, and neuropathy by 35% to 90% compared with conventional treatment, and the benefits of 6.5 years of intensive treatment extend well beyond the period of its most intensive implementation.

Association between 7 years of intensive treatment of type 1 diabetes and long-term mortality.

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.

Retinopathy in patients with type 1 diabetes 4 years after intensive therapy.

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.

Effect of Intensive Diabetes Therapy on the Progression of Diabetic Retinopathy in Patients With Type 1 Diabetes: 18 Years of Follow-up in the DCCT/EDIC

The risk of further progression of retinopathy, progression to proliferative diabetic retinopathic, clinically significant macular edema, and the need for intervention (photocoagulation or anti-VEGF) over 18 years of follow-up in EDIC is described.

Long-term effect of diabetes and its treatment on cognitive function.

No evidence of substantial long-term declines in cognitive function was found in a large group of patients with type 1 diabetes who were carefully followed for an average of 18 years, despite relatively high rates of recurrent severe hypoglycemia.

Insulin therapy, hyperglycemia, and hypertension in type 1 diabetes mellitus.

Hyperglycemia is a risk factor for incident hypertension in type 1 diabetes, and intensive insulin therapy reduces the long-term risk of developing hypertension.



The effect of long-term intensified insulin treatment on the development of microvascular complications of diabetes mellitus.

Long-term intensified insulin treatment, as compared with standard treatment, retards the development of microvascular complications in patients with insulin-dependent diabetes mellitus.

The Diabetes Control and Complications Trial (DCCT).

In both primary prevention and secondary intervention arms of the trial, intensified control reduced retinopathy risk by half or more, and also reduced nephropathy and neuropathy risks--however, risk of severe hypoglycaemic episodes was increased about three-fold.

Retinopathy in Older Type II Diabetics Association With Glucose Control

An etiologie role for metabolic control in the development of retinopathy in the elderly type II population is supported, and both the duration of diabetes and HbA1c remained significant independent determinants of Retinopathy even after taking age and blood pressure into account.

The response of diabetic retinopathy to 41 months of multiple insulin injections, insulin pumps, and conventional insulin therapy.

Transient progression of retinopathy may be related to fluctuations in blood glucose levels, although a favorable effect of long-term improved metabolic control was not documented.

Rapid tightening of blood glucose control leads to transient deterioration of retinopathy in insulin dependent diabetes mellitus: the Oslo study.

A large and rapid fall in blood glucose concentration may promote transient deterioration of diabetic retinopathy, and patients who developed cotton wool spots are characterised by a larger decrement in glycosylated haemoglobin and blood glucose values.

Two-Year Experience with Continuous Subcutaneous Insulin Infusion in Relation to Retinopathy and Neuropathy

It is concluded that near-normal blood glucose levels can be maintained with CSII therapy in spite of less frequent home-monitoring of blood glucose and outpatient visits and established background retinopathy may progress to proliferative Retinopathy in despite of 2 yr of near- normalBlood glucose levels.