Diabetes Community from HealthIndex UK

For the latest news about diabetes and the British Diabetic Association, please visit the What's New section on the British Diabetic Association's web site. "Balance a Lifestyle" is a publication produced by the British Diabetic Association. An extract of an article is reproduced here. For further articles, please visit the "Balance a Lifestyle" pages on the British Diabetic Association's web site. The Diabetes Control & Complications Trial If you have read about or heard mention of the Diabetes Control and Complications Trial (DCCT), you are probably wondering what it is and what it has to do with your diabetes. This special Balance supplement take an in depth look at the ground breaking American study and at the implications for people with diabetes in this country. What is DCCT ? The Diabetes Control and Cornplications Trial (DCCT) was a 10 year study involving 1441 people with insulin dependent diabetes throughout the USA and Canada. It was setup to compare the effects of two different types of insulin treatment on the development and progression of diabetic complications. The results that emerged were so clear that the study was stopped a year ahead of schedule, in 1993. The DCCT proved that tight blood glucose control prevents or delays the onset of complications. Every bit of improvement m your diabetes control goes some way towards lessening the risk of complications, and is even worthwhile for those who already have complications. How the study worked The participants were divided into two groups: those who had no signs of eye disease at the start of the study (primary prevention group) and those who had initial signs of eye disease and early signs of kidney disease at the start (secondary intervention group). People in the two groups were then randomly allocated to either conventional' or 'intensive' insulin treatment so that there were roughly the same number of people in each group. Intensive insulin treatment Participants were set blood glucose targets of 3.9 to 6.7 mmol/l before meals and up to 10 mmol/l after meals. They had HbA1c targets of around 6%, the upper range for non diabetic people. They had to have three or more doses of insulin a day (either by injection or insulin pump). They had to monitor their blood glucose levels four times each day and pay monthly visits to the clinic in addition to ringing the clinic on a weekly basis. Conventional insulin treatment People who received this treatment had one or two injections a day, monitored their blood glucose or urine daily and visited their clinics every three months. The results Eye disease - retinopathy - was the main complication researchers looked at but they also studied kidney, nerve and heart disease. Participants were between the ages of 13-39 years old, with no high blood pressure or high cholesterol levels. The results were striking and conclusive: The lowest incidence of complications was found amongst people receiving intensive treatment. People in the intensive group achieved blood glucose levels averaging 8.6 mmo1/l and HbA1c levels of around 7%. People in the conventional treatment group averaged a blood glucose level of 12.8 mmo1/l. Primary prevention group: Those who had no signs of retinopathy at the start and received intensive treatment had a 76% reduced risk of developing retinopathy, compared to those in the conventional treatment group. Secondary intervention group: Among those who already had signs of eye disease, intensive treatment reduced the risk of significant retinopathy by 54%, severe retinopathy by 47% and laser treatment by 56%. It took six months for people's HbA1c levels to improve in the intensive treatment group. After that, they remained lower than the conventional group for the rest of the study. Intensive treatment reduced the appearance of neuropathy (nerve disease) by 69% in the primary prevention group and 57% in the secondary intervention group. The development of kidney disease was slowed among those who had early signs of the complication at the start and received intensive treatment. Intensive treatment - not all wonderful Despite the clear benefits intensive treatment showed, there were some adverse effects. People in the intensive group gained an average of 10 lbs in weight. They also had three times more episodes of severe hypoglycaemia (requiring help from another person) than those in the conventional treatment group. Interestingly, the participants did not say that these severe hypos were detrimental to their quality of life. And no change in intellect was noted even among people who repeatedly experienced hypos. It was not possible to find one 'magic' blood glucose level where there would be minimum risk of complications without severe hypos typos or weight gain. It proved more useful to look at HbAlc levels and a clear link between these and the risk of developing complications was found. To find out what these results mean for you...visit the "Balance a Lifestyle" pages on the British Diabetic Association's web site
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For the latest news about diabetes and the British Diabetic Association, please visit the What's New section on the British Diabetic Association's web site.

"Balance a Lifestyle" is a publication produced by the British Diabetic Association. An extract of an article is reproduced here. For further articles, please visit the "Balance a Lifestyle" pages on the British Diabetic Association's web site.

The Diabetes Control & Complications Trial

If you have read about or heard mention of the Diabetes Control and Complications Trial (DCCT), you are probably wondering what it is and what it has to do with your diabetes. This special Balance supplement take an in depth look at the ground breaking American study and at the implications for people with diabetes in this country.

What is DCCT ?

The Diabetes Control and Cornplications Trial (DCCT) was a 10 year study involving 1441 people with insulin dependent diabetes throughout the USA and Canada. It was setup to compare the effects of two different types of insulin treatment on the development and progression of diabetic complications. The results that emerged were so clear that the study was stopped a year ahead of schedule, in 1993.

The DCCT proved that tight blood glucose control prevents or delays the onset of complications. Every bit of improvement m your diabetes control goes some way towards lessening the risk of complications, and is even worthwhile for those who already have complications.

How the study worked

People in the two groups were then randomly allocated to either conventional' or 'intensive' insulin treatment so that there were roughly the same number of people in each group.

Intensive insulin treatment

Participants were set blood glucose targets of 3.9 to 6.7 mmol/l before meals and up to 10 mmol/l after meals. They had HbA1c targets of around 6%, the upper range for non diabetic people. They had to have three or more doses of insulin a day (either by injection or insulin pump). They had to monitor their blood glucose levels four times each day and pay monthly visits to the clinic in addition to ringing the clinic on a weekly basis.

Conventional insulin treatment

The results

Participants were between the ages of 13-39 years old, with no high blood pressure or high cholesterol levels. The results were striking and conclusive:

The lowest incidence of complications was found amongst people receiving intensive treatment. People in the intensive group achieved blood glucose levels averaging 8.6 mmo1/l and HbA1c levels of around 7%. People in the conventional treatment group averaged a blood glucose level of 12.8 mmo1/l.
Primary prevention group: Those who had no signs of retinopathy at the start and received intensive treatment had a 76% reduced risk of developing retinopathy, compared to those in the conventional treatment group.
Secondary intervention group: Among those who already had signs of eye disease, intensive treatment reduced the risk of significant retinopathy by 54%, severe retinopathy by 47% and laser treatment by 56%.
It took six months for people's HbA1c levels to improve in the intensive treatment group. After that, they remained lower than the conventional group for the rest of the study.
Intensive treatment reduced the appearance of neuropathy (nerve disease) by 69% in the primary prevention group and 57% in the secondary intervention group.
The development of kidney disease was slowed among those who had early signs of the complication at the start and received intensive treatment.

Intensive treatment - not all wonderful

It was not possible to find one 'magic' blood glucose level where there would be minimum risk of complications without severe hypos typos or weight gain. It proved more useful to look at HbAlc levels and a clear link between these and the risk of developing complications was found.

To find out what these results mean for you...visit the "Balance a Lifestyle" pages on the British Diabetic Association's web site