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Kidney disease and related findings in the diabetes control and complications trial/epidemiology of diabetes interventions and complications study.

ABSTRACT: OBJECTIVE Kidney disease manifests clinically as elevated albumin excretion rate (AER), impaired glomerular filtration rate (GFR), or both, and is a cause of substantial morbidity and mortality in type 1 diabetes (T1D). The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study tested whether intensive diabetes therapy (INT) aimed at lowering glucose concentrations as close as safely possible to the normal range reduces the risks of kidney disease and other diabetes complications. RESEARCH DESIGN AND METHODS In the DCCT, 1,441 participants with T1D were randomly assigned to INT or conventional diabetes therapy (CON) for a mean duration of 6.5 years. Subsequently, participants have been followed for 18 years in the ongoing observational EDIC. Standardized longitudinal measurements of AER, estimated GFR, and blood pressure were made throughout the DCCT/EDIC. RESULTS During the DCCT, INT reduced the risks of incident microalbuminuria (AER ?40 mg/24 h) and macroalbuminuria (AER ?300 mg/24 h) by 39% (95% CI 21-52%) and 54% (29-74%), respectively. During EDIC years 1-8, participants previously assigned to DCCT INT continued to experience lower rates of incident microalbuminuria and macroalbuminuria, with risk reductions of 59% (39-73%) and 84% (67-92%), respectively. Beneficial effects of INT on the development of impaired GFR (sustained estimated GFR <60 mL/min/1.73 m(2)) and hypertension became evident during combined DCCT/EDIC follow-up, with risk reductions of 50% (18-69%) and 20% (6-21%), respectively, compared with CON. CONCLUSIONS In the DCCT/EDIC, INT resulted in clinically important, durable reductions in the risks of microalbuminuria, macroalbuminuria, impaired GFR, and hypertension.

SUBMITTER: de Boer IH

PROVIDER: S-EPMC3867994 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Kidney disease and related findings in the diabetes control and complications trial/epidemiology of diabetes interventions and complications study.

de Boer Ian H IH

Diabetes care 20140101 1

OBJECTIVE Kidney disease manifests clinically as elevated albumin excretion rate (AER), impaired glomerular filtration rate (GFR), or both, and is a cause of substantial morbidity and mortality in type 1 diabetes (T1D). The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study tested whether intensive diabetes therapy (INT) aimed at lowering glucose concentrations as close as safely possible to the normal range reduces the risks of ki ...[more]

PMID: 24356594

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Project description:The Diabetes Control and Complications Trial (DCCT, 1982-93) and the Epidemiology of Diabetes Interventions and Complications follow-up study (EDIC, 1994-2016) have been ongoing for more than twenty years. After a mean follow-up of approximately 16 years, the DCCT-EDIC cohort of 1,441 Type 1 diabetics had remained remarkably complete with more than 90% of the original cohort being actively followed. Taken together, the DCCT clinical trial and subsequent EDIC longitudinal follow-up provide a uniquely rich source of information on the impact of intensive therapy on glycemia and the its long-term complications for persons with Type 1 diabetes. The DCCT was a multicenter, randomized clinical trial (1, 2) designed to compare intensive with conventional diabetes therapy with regard to their effects on the development and progression of the early complications of Type 1 diabetes. The DCCT trial found that "intensive therapy effectively delays the onset and slows the progression of diabetic retinopathy, nephropathy, and neuropathy" in patients with Type 1 diabetes (1). The goal of the EDIC follow-up was to examine the longer term effects of the original DCCT interventions, especially as they apply to late-occurring complications, such as cardiovascular disease and more advanced stages of retinal and renal disease (3). The EDIC study has been remarkably fruitful in discovering the long term "imprinting" effects (metabolic memory) of the previous intensive therapy, and in delineating the interactions among risk factors with regard to microvascular complications (4-6). In addition, EDIC established, for the first time, the role of intensive therapy and chronic glycemia on atherosclerosis (7-9). Note: This study description has been prepared using materials authored by the DCCT-EDIC Data Coordinating Center. <a href="GetPdf.cgi?id=phd000390" target="_blank">DETAILED DESCRIPTION OF STUDY</a>

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Kidney disease and related findings in the diabetes control and complications trial/epidemiology of diabetes interventions and complications study.

Publications

Kidney disease and related findings in the diabetes control and complications trial/epidemiology of diabetes interventions and complications study.

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