Beneficial effects of intensive therapy of diabetes during adolescence

Outcomes after the conclusion of the Diabetes Control and Complications Trial (DCCT)

S. Genuth, D. Nathan, H. Shamoon, H. Duffy, S. Engel, H. Engel, W. Dahms, L. Mayer, Harry Shamoon, H. Zegara, D. Miller, L. Singerman, D. Brillion, M. Lackaye, M. Heinemann, F. Rahhal, V. Reppuci, T. Lee, F. Whitehouse, D. Kruger & 79 others J. D. Carey, R. Bergenstal, M. Johnson, D. Kendall, M. Spencer, D. Noller, K. Morgan, D. Etzwiler, A. Jacobson, E. Golden, D. Soroko, G. Sharuk, P. Arrigg, J. Doyle, D. Nathan, S. Fritz, S. Crowell, J. Godine, C. McKitrick, P. Lou, J. Service, G. Ziegler, J. Pach, J. Colwell, D. Wood, R. Mayfield, K. Hermayer, M. Szpiech, T. Lyons, J. Parker, A. Farr, S. Elsing, T. Thompson, M. Molitch, B. Schaefer, L. Jampol, D. Weinberg, A. Lyon, O. Kolterman, G. Lorenzi, M. Goldbaum, W. Sivitz, M. Bayless, R. Zeither, T. Weingeist, E. Stone, H. Culver Boidt, K. Gehries, S. Russell, D. Counts, A. Kowarski, D. Ostrowski, T. Donner, S. Steidl, B. Jones, W. Herman, D. Greene, C. Martin, M. J. Stevens, A. K. Vine, S. Elner, J. Bantle, B. Rogness, T. Olsen, E. Steuer, S. Kaushel, D. Goldstein, S. Hitt, J. Giangiacomo, L. D. Ormerod, D. Schade, J. Canady, M. Schluster, A. Das, D. Hornbeck, S. Schwartz, B. J. Maschak-Carey, L. Baker, S. Braunstein

Research output: Contribution to journalArticle

326 Citations (Scopus)

Abstract

Objective: The Diabetes Control and Complications Trial (DCCT) demonstrated that intensive therapy of type 1 diabetes mellitus reduces the risk of development and progression of microvascular complications. The Epidemiology of Diabetes Interventions and Complications (EDIC) study assessed whether these benefits persisted after the end of DCCT. Results for the adolescent DCCT cohort are reported here. Study design: Of the DCCT adolescent cohort (n = 195), 175 participated in EDIC, 151 had fundus photography, and 156 had albumin excretion rate measured at year 3 or 4. The odds of progression of retinopathy and albuminuria from closeout of the DCCT until EDIC year 4 were assessed. Results: In contrast to the 7.4 years of the DCCT, during which mean hemoglobin A1c levels were significantly lower with intensive therapy than conventional therapy (8.06% vs 9.76%; P < .0001), the subsequent first 4 years of EDIC had mean hemoglobin A1c levels that were similar between the former intensive and the former conventional groups (8.38% vs 8.45%). However, the prevalence of worsening of 3 steps or more in retinopathy and of progression to proliferative or severe nonproliferative retinopathy were reduced by 74% (P < .001) and 78% (P < .007), respectively, in the former intensive therapy group compared with the former conventional group. Conclusions: These findings provide further support for the DCCT recommendation that most adolescents with type 1 diabetes receive intensive therapy aimed at achieving glycemic control as close to normal as possible to reduce the risk of microvascular complications.

Original languageEnglish (US)
Pages (from-to)804-812
Number of pages9
JournalJournal of Pediatrics
Volume139
Issue number6
DOIs
StatePublished - 2001
Externally publishedYes

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Diabetes Complications
Epidemiology
Therapeutics
Type 1 Diabetes Mellitus
Hemoglobins
Albuminuria
Photography
Group Psychotherapy
Albumins

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Beneficial effects of intensive therapy of diabetes during adolescence : Outcomes after the conclusion of the Diabetes Control and Complications Trial (DCCT). / Genuth, S.; Nathan, D.; Shamoon, H.; Duffy, H.; Engel, S.; Engel, H.; Dahms, W.; Mayer, L.; Shamoon, Harry; Zegara, H.; Miller, D.; Singerman, L.; Brillion, D.; Lackaye, M.; Heinemann, M.; Rahhal, F.; Reppuci, V.; Lee, T.; Whitehouse, F.; Kruger, D.; Carey, J. D.; Bergenstal, R.; Johnson, M.; Kendall, D.; Spencer, M.; Noller, D.; Morgan, K.; Etzwiler, D.; Jacobson, A.; Golden, E.; Soroko, D.; Sharuk, G.; Arrigg, P.; Doyle, J.; Nathan, D.; Fritz, S.; Crowell, S.; Godine, J.; McKitrick, C.; Lou, P.; Service, J.; Ziegler, G.; Pach, J.; Colwell, J.; Wood, D.; Mayfield, R.; Hermayer, K.; Szpiech, M.; Lyons, T.; Parker, J.; Farr, A.; Elsing, S.; Thompson, T.; Molitch, M.; Schaefer, B.; Jampol, L.; Weinberg, D.; Lyon, A.; Kolterman, O.; Lorenzi, G.; Goldbaum, M.; Sivitz, W.; Bayless, M.; Zeither, R.; Weingeist, T.; Stone, E.; Culver Boidt, H.; Gehries, K.; Russell, S.; Counts, D.; Kowarski, A.; Ostrowski, D.; Donner, T.; Steidl, S.; Jones, B.; Herman, W.; Greene, D.; Martin, C.; Stevens, M. J.; Vine, A. K.; Elner, S.; Bantle, J.; Rogness, B.; Olsen, T.; Steuer, E.; Kaushel, S.; Goldstein, D.; Hitt, S.; Giangiacomo, J.; Ormerod, L. D.; Schade, D.; Canady, J.; Schluster, M.; Das, A.; Hornbeck, D.; Schwartz, S.; Maschak-Carey, B. J.; Baker, L.; Braunstein, S.

In: Journal of Pediatrics, Vol. 139, No. 6, 2001, p. 804-812.

Research output: Contribution to journalArticle

Genuth, S, Nathan, D, Shamoon, H, Duffy, H, Engel, S, Engel, H, Dahms, W, Mayer, L, Shamoon, H, Zegara, H, Miller, D, Singerman, L, Brillion, D, Lackaye, M, Heinemann, M, Rahhal, F, Reppuci, V, Lee, T, Whitehouse, F, Kruger, D, Carey, JD, Bergenstal, R, Johnson, M, Kendall, D, Spencer, M, Noller, D, Morgan, K, Etzwiler, D, Jacobson, A, Golden, E, Soroko, D, Sharuk, G, Arrigg, P, Doyle, J, Nathan, D, Fritz, S, Crowell, S, Godine, J, McKitrick, C, Lou, P, Service, J, Ziegler, G, Pach, J, Colwell, J, Wood, D, Mayfield, R, Hermayer, K, Szpiech, M, Lyons, T, Parker, J, Farr, A, Elsing, S, Thompson, T, Molitch, M, Schaefer, B, Jampol, L, Weinberg, D, Lyon, A, Kolterman, O, Lorenzi, G, Goldbaum, M, Sivitz, W, Bayless, M, Zeither, R, Weingeist, T, Stone, E, Culver Boidt, H, Gehries, K, Russell, S, Counts, D, Kowarski, A, Ostrowski, D, Donner, T, Steidl, S, Jones, B, Herman, W, Greene, D, Martin, C, Stevens, MJ, Vine, AK, Elner, S, Bantle, J, Rogness, B, Olsen, T, Steuer, E, Kaushel, S, Goldstein, D, Hitt, S, Giangiacomo, J, Ormerod, LD, Schade, D, Canady, J, Schluster, M, Das, A, Hornbeck, D, Schwartz, S, Maschak-Carey, BJ, Baker, L & Braunstein, S 2001, 'Beneficial effects of intensive therapy of diabetes during adolescence: Outcomes after the conclusion of the Diabetes Control and Complications Trial (DCCT)', Journal of Pediatrics, vol. 139, no. 6, pp. 804-812. https://doi.org/10.1067/mpd.2001.118887
Genuth, S. ; Nathan, D. ; Shamoon, H. ; Duffy, H. ; Engel, S. ; Engel, H. ; Dahms, W. ; Mayer, L. ; Shamoon, Harry ; Zegara, H. ; Miller, D. ; Singerman, L. ; Brillion, D. ; Lackaye, M. ; Heinemann, M. ; Rahhal, F. ; Reppuci, V. ; Lee, T. ; Whitehouse, F. ; Kruger, D. ; Carey, J. D. ; Bergenstal, R. ; Johnson, M. ; Kendall, D. ; Spencer, M. ; Noller, D. ; Morgan, K. ; Etzwiler, D. ; Jacobson, A. ; Golden, E. ; Soroko, D. ; Sharuk, G. ; Arrigg, P. ; Doyle, J. ; Nathan, D. ; Fritz, S. ; Crowell, S. ; Godine, J. ; McKitrick, C. ; Lou, P. ; Service, J. ; Ziegler, G. ; Pach, J. ; Colwell, J. ; Wood, D. ; Mayfield, R. ; Hermayer, K. ; Szpiech, M. ; Lyons, T. ; Parker, J. ; Farr, A. ; Elsing, S. ; Thompson, T. ; Molitch, M. ; Schaefer, B. ; Jampol, L. ; Weinberg, D. ; Lyon, A. ; Kolterman, O. ; Lorenzi, G. ; Goldbaum, M. ; Sivitz, W. ; Bayless, M. ; Zeither, R. ; Weingeist, T. ; Stone, E. ; Culver Boidt, H. ; Gehries, K. ; Russell, S. ; Counts, D. ; Kowarski, A. ; Ostrowski, D. ; Donner, T. ; Steidl, S. ; Jones, B. ; Herman, W. ; Greene, D. ; Martin, C. ; Stevens, M. J. ; Vine, A. K. ; Elner, S. ; Bantle, J. ; Rogness, B. ; Olsen, T. ; Steuer, E. ; Kaushel, S. ; Goldstein, D. ; Hitt, S. ; Giangiacomo, J. ; Ormerod, L. D. ; Schade, D. ; Canady, J. ; Schluster, M. ; Das, A. ; Hornbeck, D. ; Schwartz, S. ; Maschak-Carey, B. J. ; Baker, L. ; Braunstein, S. / Beneficial effects of intensive therapy of diabetes during adolescence : Outcomes after the conclusion of the Diabetes Control and Complications Trial (DCCT). In: Journal of Pediatrics. 2001 ; Vol. 139, No. 6. pp. 804-812.
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title = "Beneficial effects of intensive therapy of diabetes during adolescence: Outcomes after the conclusion of the Diabetes Control and Complications Trial (DCCT)",
abstract = "Objective: The Diabetes Control and Complications Trial (DCCT) demonstrated that intensive therapy of type 1 diabetes mellitus reduces the risk of development and progression of microvascular complications. The Epidemiology of Diabetes Interventions and Complications (EDIC) study assessed whether these benefits persisted after the end of DCCT. Results for the adolescent DCCT cohort are reported here. Study design: Of the DCCT adolescent cohort (n = 195), 175 participated in EDIC, 151 had fundus photography, and 156 had albumin excretion rate measured at year 3 or 4. The odds of progression of retinopathy and albuminuria from closeout of the DCCT until EDIC year 4 were assessed. Results: In contrast to the 7.4 years of the DCCT, during which mean hemoglobin A1c levels were significantly lower with intensive therapy than conventional therapy (8.06{\%} vs 9.76{\%}; P < .0001), the subsequent first 4 years of EDIC had mean hemoglobin A1c levels that were similar between the former intensive and the former conventional groups (8.38{\%} vs 8.45{\%}). However, the prevalence of worsening of 3 steps or more in retinopathy and of progression to proliferative or severe nonproliferative retinopathy were reduced by 74{\%} (P < .001) and 78{\%} (P < .007), respectively, in the former intensive therapy group compared with the former conventional group. Conclusions: These findings provide further support for the DCCT recommendation that most adolescents with type 1 diabetes receive intensive therapy aimed at achieving glycemic control as close to normal as possible to reduce the risk of microvascular complications.",
author = "S. Genuth and D. Nathan and H. Shamoon and H. Duffy and S. Engel and H. Engel and W. Dahms and L. Mayer and Harry Shamoon and H. Zegara and D. Miller and L. Singerman and D. Brillion and M. Lackaye and M. Heinemann and F. Rahhal and V. Reppuci and T. Lee and F. Whitehouse and D. Kruger and Carey, {J. D.} and R. Bergenstal and M. Johnson and D. Kendall and M. Spencer and D. Noller and K. Morgan and D. Etzwiler and A. Jacobson and E. Golden and D. Soroko and G. Sharuk and P. Arrigg and J. Doyle and D. Nathan and S. Fritz and S. Crowell and J. Godine and C. McKitrick and P. Lou and J. Service and G. Ziegler and J. Pach and J. Colwell and D. Wood and R. Mayfield and K. Hermayer and M. Szpiech and T. Lyons and J. Parker and A. Farr and S. Elsing and T. Thompson and M. Molitch and B. Schaefer and L. Jampol and D. Weinberg and A. Lyon and O. Kolterman and G. Lorenzi and M. Goldbaum and W. Sivitz and M. Bayless and R. Zeither and T. Weingeist and E. Stone and {Culver Boidt}, H. and K. Gehries and S. Russell and D. Counts and A. Kowarski and D. Ostrowski and T. Donner and S. Steidl and B. Jones and W. Herman and D. Greene and C. Martin and Stevens, {M. J.} and Vine, {A. K.} and S. Elner and J. Bantle and B. Rogness and T. Olsen and E. Steuer and S. Kaushel and D. Goldstein and S. Hitt and J. Giangiacomo and Ormerod, {L. D.} and D. Schade and J. Canady and M. Schluster and A. Das and D. Hornbeck and S. Schwartz and Maschak-Carey, {B. J.} and L. Baker and S. Braunstein",
year = "2001",
doi = "10.1067/mpd.2001.118887",
language = "English (US)",
volume = "139",
pages = "804--812",
journal = "Journal of Pediatrics",
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TY - JOUR

T1 - Beneficial effects of intensive therapy of diabetes during adolescence

T2 - Outcomes after the conclusion of the Diabetes Control and Complications Trial (DCCT)

AU - Genuth, S.

AU - Nathan, D.

AU - Shamoon, H.

AU - Duffy, H.

AU - Engel, S.

AU - Engel, H.

AU - Dahms, W.

AU - Mayer, L.

AU - Shamoon, Harry

AU - Zegara, H.

AU - Miller, D.

AU - Singerman, L.

AU - Brillion, D.

AU - Lackaye, M.

AU - Heinemann, M.

AU - Rahhal, F.

AU - Reppuci, V.

AU - Lee, T.

AU - Whitehouse, F.

AU - Kruger, D.

AU - Carey, J. D.

AU - Bergenstal, R.

AU - Johnson, M.

AU - Kendall, D.

AU - Spencer, M.

AU - Noller, D.

AU - Morgan, K.

AU - Etzwiler, D.

AU - Jacobson, A.

AU - Golden, E.

AU - Soroko, D.

AU - Sharuk, G.

AU - Arrigg, P.

AU - Doyle, J.

AU - Nathan, D.

AU - Fritz, S.

AU - Crowell, S.

AU - Godine, J.

AU - McKitrick, C.

AU - Lou, P.

AU - Service, J.

AU - Ziegler, G.

AU - Pach, J.

AU - Colwell, J.

AU - Wood, D.

AU - Mayfield, R.

AU - Hermayer, K.

AU - Szpiech, M.

AU - Lyons, T.

AU - Parker, J.

AU - Farr, A.

AU - Elsing, S.

AU - Thompson, T.

AU - Molitch, M.

AU - Schaefer, B.

AU - Jampol, L.

AU - Weinberg, D.

AU - Lyon, A.

AU - Kolterman, O.

AU - Lorenzi, G.

AU - Goldbaum, M.

AU - Sivitz, W.

AU - Bayless, M.

AU - Zeither, R.

AU - Weingeist, T.

AU - Stone, E.

AU - Culver Boidt, H.

AU - Gehries, K.

AU - Russell, S.

AU - Counts, D.

AU - Kowarski, A.

AU - Ostrowski, D.

AU - Donner, T.

AU - Steidl, S.

AU - Jones, B.

AU - Herman, W.

AU - Greene, D.

AU - Martin, C.

AU - Stevens, M. J.

AU - Vine, A. K.

AU - Elner, S.

AU - Bantle, J.

AU - Rogness, B.

AU - Olsen, T.

AU - Steuer, E.

AU - Kaushel, S.

AU - Goldstein, D.

AU - Hitt, S.

AU - Giangiacomo, J.

AU - Ormerod, L. D.

AU - Schade, D.

AU - Canady, J.

AU - Schluster, M.

AU - Das, A.

AU - Hornbeck, D.

AU - Schwartz, S.

AU - Maschak-Carey, B. J.

AU - Baker, L.

AU - Braunstein, S.

PY - 2001

Y1 - 2001

N2 - Objective: The Diabetes Control and Complications Trial (DCCT) demonstrated that intensive therapy of type 1 diabetes mellitus reduces the risk of development and progression of microvascular complications. The Epidemiology of Diabetes Interventions and Complications (EDIC) study assessed whether these benefits persisted after the end of DCCT. Results for the adolescent DCCT cohort are reported here. Study design: Of the DCCT adolescent cohort (n = 195), 175 participated in EDIC, 151 had fundus photography, and 156 had albumin excretion rate measured at year 3 or 4. The odds of progression of retinopathy and albuminuria from closeout of the DCCT until EDIC year 4 were assessed. Results: In contrast to the 7.4 years of the DCCT, during which mean hemoglobin A1c levels were significantly lower with intensive therapy than conventional therapy (8.06% vs 9.76%; P < .0001), the subsequent first 4 years of EDIC had mean hemoglobin A1c levels that were similar between the former intensive and the former conventional groups (8.38% vs 8.45%). However, the prevalence of worsening of 3 steps or more in retinopathy and of progression to proliferative or severe nonproliferative retinopathy were reduced by 74% (P < .001) and 78% (P < .007), respectively, in the former intensive therapy group compared with the former conventional group. Conclusions: These findings provide further support for the DCCT recommendation that most adolescents with type 1 diabetes receive intensive therapy aimed at achieving glycemic control as close to normal as possible to reduce the risk of microvascular complications.

AB - Objective: The Diabetes Control and Complications Trial (DCCT) demonstrated that intensive therapy of type 1 diabetes mellitus reduces the risk of development and progression of microvascular complications. The Epidemiology of Diabetes Interventions and Complications (EDIC) study assessed whether these benefits persisted after the end of DCCT. Results for the adolescent DCCT cohort are reported here. Study design: Of the DCCT adolescent cohort (n = 195), 175 participated in EDIC, 151 had fundus photography, and 156 had albumin excretion rate measured at year 3 or 4. The odds of progression of retinopathy and albuminuria from closeout of the DCCT until EDIC year 4 were assessed. Results: In contrast to the 7.4 years of the DCCT, during which mean hemoglobin A1c levels were significantly lower with intensive therapy than conventional therapy (8.06% vs 9.76%; P < .0001), the subsequent first 4 years of EDIC had mean hemoglobin A1c levels that were similar between the former intensive and the former conventional groups (8.38% vs 8.45%). However, the prevalence of worsening of 3 steps or more in retinopathy and of progression to proliferative or severe nonproliferative retinopathy were reduced by 74% (P < .001) and 78% (P < .007), respectively, in the former intensive therapy group compared with the former conventional group. Conclusions: These findings provide further support for the DCCT recommendation that most adolescents with type 1 diabetes receive intensive therapy aimed at achieving glycemic control as close to normal as possible to reduce the risk of microvascular complications.

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UR - http://www.scopus.com/inward/citedby.url?scp=0035663189&partnerID=8YFLogxK

U2 - 10.1067/mpd.2001.118887

DO - 10.1067/mpd.2001.118887

M3 - Article

VL - 139

SP - 804

EP - 812

JO - Journal of Pediatrics

JF - Journal of Pediatrics

SN - 0022-3476

IS - 6

ER -