DCCT Trial….in 5 minutes

Aftab Aziz19/12/13

1441 pt with T1DM

Primary Prevention n=726

Conventional therapy n=378

Intensive therapy n=348

Secondary Prevention

n=715

Conventional therapyn=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

• HbA1c improvement in intensive vs. conventional treated group (p0.001)

• Mean glucose level 8.6mmol/l vs. 12.8mmol/l (p<0.001)

Glycemic control

5.5

8.3

11.1

13.8

16.6

• Primary prevention group (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

Retinopathy

• Primary prevention group– 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

Nephropathy

• Primary Prevention group– 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)

Neuropathy

• Severe hypoglycemic episodes 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)

Secondary analysis