Beneficial effects of intensive therapy of diabetes during adolescence: Outcomes after the conclusion of the Diabetes Control and Complications Trial (DCCT)

2001 ◽  
Vol 139 (6) ◽  
pp. 804-812 ◽  
Keyword(s):  
Intensive Therapy ◽  
Diabetes Control ◽  
Beneficial Effects

scholarly journals Understanding Metabolic Memory: The Prolonged Influence of Glycemia During the Diabetes Control and Complications Trial (DCCT) on Future Risks of Complications During the Study of the Epidemiology of Diabetes Interventions and Complications (EDIC)

2021 ◽  
Author(s):  
John M. Lachin ◽  
David M. Nathan ◽  
the DCCT/EDIC Research Group
Keyword(s):  
Conventional Therapy ◽  
Microvascular Complications ◽  
Intensive Therapy ◽  
Diabetes Control ◽  
Metabolic Memory ◽  
Beneficial Effects ◽  
Legacy Effect ◽  
Hba1c Levels ◽  
Diabetes Interventions

The Diabetes Control and Complications Trial (DCCT, 1983-1993) showed that intensive therapy (mean HbA1c 7.2%) compared with conventional therapy (mean HbA1c 9.0%) markedly reduced the risks of retinopathy, nephropathy and neuropathy, and these reductions in complications were entirely attributable, statistically, to the difference in mean HbA1c levels. The DCCT cohort has been followed in the Epidemiology of Diabetes Interventions and Complications study (EDIC, 1994 to date). <p>Early in EDIC, mean HbA1c levels in the former intensively and conventionally treated groups converged. Nevertheless, the beneficial effects of DCCT intensive versus conventional therapy on microvascular complications not only persisted but increased during EDIC. The differences in complications during EDIC were wholly explained, statistically, by differences between groups in HbA1c levels during DCCT. These observations give rise to the concept of metabolic memory. Subsequent similar findings from the UKPDS gave rise to a similar concept, which they called the legacy effect. </p> <p>In this report, we present the evidence to support metabolic memory as both a biological and epidemiological phenomenon, and discuss potential underlying mechanisms. We also compare metabolic memory and the legacy effect and conclude that the two are likely biologically similar, with comparable effects on long-term outcomes.</p> <p>The long-term influence of metabolic memory on the risk of micro- and macrovascular complications supports the implementation of intensive therapy, with the goal of maintaining near normal levels of glycemia, as early and as long as safely possible in order to limit the risk of complications.</p>

scholarly journals Understanding Metabolic Memory: The Prolonged Influence of Glycemia During the Diabetes Control and Complications Trial (DCCT) on Future Risks of Complications During the Study of the Epidemiology of Diabetes Interventions and Complications (EDIC)

2021 ◽  
Author(s):  
John M. Lachin ◽  
David M. Nathan ◽  
the DCCT/EDIC Research Group
Keyword(s):  
Conventional Therapy ◽  
Microvascular Complications ◽  
Intensive Therapy ◽  
Diabetes Control ◽  
Metabolic Memory ◽  
Beneficial Effects ◽  
Legacy Effect ◽  
Hba1c Levels ◽  
Diabetes Interventions

The Diabetes Control and Complications Trial (DCCT, 1983-1993) showed that intensive therapy (mean HbA1c 7.2%) compared with conventional therapy (mean HbA1c 9.0%) markedly reduced the risks of retinopathy, nephropathy and neuropathy, and these reductions in complications were entirely attributable, statistically, to the difference in mean HbA1c levels. The DCCT cohort has been followed in the Epidemiology of Diabetes Interventions and Complications study (EDIC, 1994 to date). <p>Early in EDIC, mean HbA1c levels in the former intensively and conventionally treated groups converged. Nevertheless, the beneficial effects of DCCT intensive versus conventional therapy on microvascular complications not only persisted but increased during EDIC. The differences in complications during EDIC were wholly explained, statistically, by differences between groups in HbA1c levels during DCCT. These observations give rise to the concept of metabolic memory. Subsequent similar findings from the UKPDS gave rise to a similar concept, which they called the legacy effect. </p> <p>In this report, we present the evidence to support metabolic memory as both a biological and epidemiological phenomenon, and discuss potential underlying mechanisms. We also compare metabolic memory and the legacy effect and conclude that the two are likely biologically similar, with comparable effects on long-term outcomes.</p> <p>The long-term influence of metabolic memory on the risk of micro- and macrovascular complications supports the implementation of intensive therapy, with the goal of maintaining near normal levels of glycemia, as early and as long as safely possible in order to limit the risk of complications.</p>

Beyond the Diabetes Control and Complications Trial—Addressing Weight Gain in Type 1 Diabetes

2008 ◽  
Vol 04 (01) ◽  
pp. 62 ◽  
Author(s):  
Jonathan Purnell
Keyword(s):  
Type 1 Diabetes ◽  
Weight Gain ◽  
Microvascular Complications ◽  
Intensive Therapy ◽  
Diabetes Control ◽  
Controlled Clinical Trial ◽  
Normal Range ◽  
Randomised Controlled ◽  
Blood Glucose Concentrations

The Diabetes Control and Complications Trial (DCCT) was a prospective, randomised, controlled clinical trial that began in the 1980s and was carried out over a decade to determine whether intensive treatment aimed at maintaining blood glucose concentrations close to the normal range could decrease the frequency and severity of microvascular complications in patients with type 1 diabetes. The results showed that intensive therapy effectively delays the onset and progression of diabetic retinopathy, nephropathy, and neuropathy in patients with type 1 diabetes.1The side effects associated with intensive therapy were a nearly three-fold increased frequency of severe hypoglycaemia and greater weight gain. For the majority of patients with type 1 diabetes, the benefits of intensive therapy were considered to vastly outweigh these risks. However, the potential detrimental effects of weight gain, especially on macrovascular risks, are being revisited.

Nutrition interventions for intensive therapy in the diabetes control and complications trial

1993 ◽  
Vol 93 (7) ◽  
pp. 768-772 ◽  
Author(s):  
Ellen J Anderson ◽  
Linda Delahanty ◽  
Maryanne Richardson ◽  
Gay Castle ◽  
Susan Cercone ◽  
...  
Keyword(s):  
Intensive Therapy ◽  
Diabetes Control ◽  
Nutrition Interventions

Glycated protein update: implications of recent studies, including the diabetes control and complications trial

1994 ◽  
Vol 40 (5) ◽  
pp. 683-687 ◽  
Author(s):  
R J Benjamin ◽  
D B Sacks
Keyword(s):  
Blood Glucose ◽  
Serum Proteins ◽  
Intensive Therapy ◽  
Blood Glucose Control ◽  
Diabetes Control ◽  
Fine Tuning ◽  
Diabetic Patients ◽  
Therapeutic Goals ◽  
Increased Risk ◽  
Insulin Dependent Diabetic

Abstract On the basis of the results of the Diabetes Control and Complications Trial (DCCT), the American Diabetes Association (ADA) now recommends tight control of blood glucose to near-normal concentrations as the primary goal for most eligible insulin-dependent diabetic patients. In the DCCT, intensive therapeutic intervention was based on frequent self-monitoring of blood glucose and monthly measurements of glycohemoglobin. The importance of glycohemoglobin assessments serves to highlight the present inadequacies in laboratory measurements of this analyte, which hinders wide implementation of the ADA recommendations. Clinical interventions aimed at achieving the DCCT's published therapeutic goals may place patients at a significantly increased risk for life-threatening hypoglycemia, if the therapy is based on nonstandardized laboratory results. Clinical laboratories will now be under increasing pressure to provide reproducible, standardized measurements of glycohemoglobin, a goal that recent research has shown to be realistic, if widespread interlaboratory calibration is adopted. Finally, recent advances in measuring glycated serum proteins appear to warrant reevaluation of such assays during future intensive therapy trials, as potentially important tools for fine-tuning tight blood glucose control.

scholarly journals Epigenomic profiling reveals an association between persistence of DNA methylation and metabolic memory in the DCCT/EDIC type 1 diabetes cohort

2016 ◽  
Vol 113 (21) ◽  
pp. E3002-E3011 ◽  
Author(s):  
Zhuo Chen ◽  
Feng Miao ◽  
Andrew D. Paterson ◽  
John M. Lachin ◽  
Lingxiao Zhang ◽  
...  
Keyword(s):  
Dna Methylation ◽  
Conventional Therapy ◽  
Therapy Group ◽  
Intensive Therapy ◽  
Metabolic Memory ◽  
Blood Monocytes ◽  
Interacting Protein ◽  
Thioredoxin Interacting Protein ◽  
Beneficial Effects

We examined whether persistence of epigenetic DNA methylation (DNA-me) alterations at specific loci over two different time points in people with diabetes are associated with metabolic memory, the prolonged beneficial effects of intensive vs. conventional therapy during the Diabetes Control and Complications Trial (DCCT) on the progression of microvascular outcomes in the long-term follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) Study. We compared DNA-me profiles in genomic DNA of whole blood (WB) isolated at EDIC Study baseline from 32 cases (DCCT conventional therapy group subjects showing retinopathy or albuminuria progression by EDIC Study year 10) vs. 31 controls (DCCT intensive therapy group subjects without complication progression by EDIC year 10). DNA-me was also profiled in blood monocytes (Monos) of the same patients obtained during EDIC Study years 16–17. In WB, 153 loci depicted hypomethylation, and 225 depicted hypermethylation, whereas in Monos, 155 hypomethylated loci and 247 hypermethylated loci were found (fold change ≥1.3; P < 0.005; cases vs. controls). Twelve annotated differentially methylated loci were common in both WB and Monos, including thioredoxin-interacting protein (TXNIP), known to be associated with hyperglycemia and related complications. A set of differentially methylated loci depicted similar trends of associations with prior HbA1c in both WB and Monos. In vitro, high glucose induced similar persistent hypomethylation at TXNIP in cultured THP1 Monos. These results show that DNA-me differences during the DCCT persist at certain loci associated with glycemia for several years during the EDIC Study and support an epigenetic explanation for metabolic memory.

Are School Nurses Using the Recommendations of the Diabetes Control and Complications Trial in the Care of Students with Diabetes?

2002 ◽  
Vol 18 (3) ◽  
pp. 138-143 ◽  
Author(s):  
Monica Blum
Keyword(s):  
Quality Of Life ◽  
Chronic Diseases ◽  
Americans With Disabilities Act ◽  
Intensive Therapy ◽  
School Nurses ◽  
Diabetes Control ◽  
Large Numbers

Diabetes is one of the most common chronic diseases of childhood. It is listed as a disabling condition under the Americans with Disabilities Act, and therefore accommodations must be made for these children in school. School nurses are responsible for large numbers of children, usually in more than one setting. The Diabetes Control and Complications Trial examined intensive therapy and its effects on the long-term morbidity and quality of life of diabetic adolescents. A number of recommendations were made that apply to school nurses. The purpose of this article is to determine if any studies have been conducted to explore whether school nurses are using the results of the Diabetes Control and Complications Trial to write individualized healthcare plans defining the care of students with diabetes.

scholarly journals Aspiration lipoid pneumonia in a child 1.5 years

2020 ◽  
Vol 11 (2) ◽  
pp. 85-92
Author(s):  
Kristina V. Budarova ◽  
Aleksey N. Shmakov ◽  
Vladimir A. Bokut ◽  
Diana Yu. Makarova ◽  
Mariya A. Polonskaya ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Intensive Therapy ◽  
Physiological Basis ◽  
Lipoid Pneumonia ◽  
Beneficial Effects ◽  
Bronchial Aspirate ◽  
Therapeutic Measures ◽  
Late Start ◽  
Ventilation Of The Lungs ◽  
Selection Of

Aspirated lipoid pneumonia is a rare lung disease, in which interstitial lesion with chronic respiratory failure is predominantly expressed. In the available literature, this pathology is described in the form of separate observations with an empirical selection of therapeutic measures. The appearance of lipophages in a bronchial aspirate is recognized as a pathognomonic sign of lipoid pneumonia. There is no etiological treatment of the disease. The effectiveness of intensive therapy, according to available sources, depends on the severity of respiratory failure and on the timing of the start of complex bronchodrainage therapy, and theoretically the most attractive is kinesitherapy. Only one observation describes the use of bronchial lavage with sequential separate intubation of the main bronchi. Hormone therapy is considered effective, but the physiological basis for its use is not presented. The published observation is characterized by a late start of treatment due to a long diagnostic search. The applied therapeutic measures are given and described in detail with an assessment of the expected and achieved practical benefits. It was shown that beneficial effects were due to the use of bronchodrainage therapy techniques, including the jet high-frequency artificial ventilation of the lungs. There are doubts about the appropriateness of the use of corticosteroids in this pathology.

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