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Clinical corner

There is a wealth of publications within the diabetes area. Several interesting scientific articles have been groundbreaking and had implications on guidelines for diabetes management. Below are 3 major studies which have impacted the area. 

  1. United Kingdom Prospective Diabetes Study (UKPDS)

    The United Kingdom Prospective Diabetes Study was a landmark randomized, multicenter trial of glycaemic therapies in 5,102 patients with newly diagnosed type 2 diabetes. It ran for twenty years (1977 to 1997) in 23 UK clinical sites and showed conclusively that the complications of type 2 diabetes, previously often regarded as inevitable, could be reduced by improving blood glucose and/or blood pressure control. 

    Study findings: Each percentage unit reduction in HbA1c was associated with risk reduction of 1. Microvascular disease -37% 2. Deaths related to diabetes -21% 3. Myocardial infarction -14% 

  2. Diabetes Control and Complication Trial (DCCT)

    DCCT was a major clinical study conducted from 1983 to 1993 and funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The study showed that keeping blood glucose levels as close to normal as possible slows the onset and progression of the eye, kidney and nerve damage caused by diabetes. In fact, it demonstrated that any sustained lowering of blood glucose, also called blood sugar, helps, even if the person has a history of poor control.

    The DCCT involved 1,441 volunteers, ages 13 to 39 with type 1 diabetes and 29 medical centers in the United States and Canada. Volunteers had to have had diabetes for at least 1 year but no longer than 15 years. They also were required to have no, or only early signs, of diabetic eye disease. The study compared the effects of standard control of blood glucose versus intensive control on the complications of diabetes. Intensive control meant keeping HbA1c levels as close as possible to the normal value of 6 percent or less. Volunteers were randomly assigned to each treatment group.

    Study findings: Intensive blood glucose control reduces risk of 1. Eye disease -76% 2. Kidney disease – 50% 3. Nerve disease – 60%

  3. Epidemiology of Diabetes Intervention and Complications (EDIC)

    When the DCCT ended in 1993, researchers continued to study more than 9 percent of the participants. The follow-up study, called Epidemiology of Diabetes Interventions and Complications (EDIC), is assessing the incidence and predictors of cardiovascular disease events such as heart attack, stroke, or needed heart surgery, as well as diabetic complications related to the eye, kidney, and nerves. The EDIC study is also examining the impact of intensive control versus standard control on quality of life. Another objective is to look at the cost-effectiveness of intensive control.

    Study findings: Intensive blood glucose control reduces risk of 1. Any cardiovascular disease event -42% 2. Nonfatal heart attack, stroke, or death from cardiovascular causes -57% 
 

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