DCCT overview

DCCT overview

• 1.
  Aftab Aziz 19/12/13
• 2.
  1441 pt withT1DM Secondary Prevention Primary Prevention n=726 Conventional therapy n=378 • • • • • Intensive therapy n=348 n=715 Conventional therapy n=352 Intensive therapy n=363 Randomised, multicentre trial 1441 pts recruited from 29 centres 1983-89 Av follow-up was 6.5 yrs (mean 3-9) Inclusion age 13-39 yrs, Type 1 DM Primary prevention arm – 1-5 yrs DM, no retinopathy or nephropathy • Secondary prevention arm – 1-15yrs DM, M NPRetinopathy, Ur Microalb <200mg/24 hrs
• 3.
  Glycemic control 16.6 13.8 11.1 8.3 5.5 • HbA1cimprovement in intensive vs. conventional treated group (p0.001) • Mean glucose level 8.6mmol/l vs. 12.8mmol/l (p<0.001)
• 4.
  Retinopathy • Primary preventiongroup (Intensive vs. conventional) – 23 vs 91 pts developed retinopathy in 6 years followup (Mean risk reduction 76%) • Secondary prevention group (Intensive vs. conventional) – 77 vs 143 pts developed progressive retinopathy (Mean risk reduction 54%) – 47% reduction of severe retinopathy, 56% reduction in laser photocoagulation • Transient worsening of retinopathy (22% vs. 13%) 18 months
• 5.
  Nephropathy • Primary preventiongroup – Mean risk reduction for microalbuminuria by 34% (p 0.04) intensive gp • Secondary prevention group – Mean risk reduction for microalbuminuria by 43% (p 0.001) intensive gp • Risk reduction in albuminuria (54%) and microalbunimuria (39%) in intensive treatment arms
• 6.
  Neuropathy • Primary Preventiongroup – 3% vs 10% developed neuropathy (69% reduction of neuropathy by 5 years, p0.006) • Secondary Prevention group – 7% vs 16% developed neuropathy (57% reduction of neuropathy by 5 years)
• 7.
  Secondary analysis • • • • • • • Severe hypoglycemicepisodes 62 vs. 19/100 pt yrs Hypoglycemia Coma / seizure episodes 16 vs. 5/100 pt yrs Hospitalisation 54/40 pts vs. 36/27 pts Major accidents 20 vs. 22 (2 fatalities, 1 vs. 1) No difference in neuropsycholgical function No death, MI or stroke Wt gain ( overweight 12.7 vs. 9.3 /100 pt yrs)