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document
Effect of intensive therapy on the microvascular complications of type 1 diabetes mellitus . The purpose of this report is to summarize and integrate the findings of the Diabetes Control and Complications Trial ( DCCT ) , a randomized controlled clinical trial , and the succeeding observational follow-up of the DCCT cohort in the Epidemiology of Diabetes Interventions and Complications ( EDIC ) study , regarding the effects of intensive treatment on the microvascular complications of type 1 diabetes mellitus . The DCCT proved that intensive treatment reduced the risks of retinopathy , nephropathy , and neuropathy by 35 % to 90 % compared with conventional treatment . The absolute risks of retinopathy and nephropathy were proportional to the mean glycosylated hemoglobin ( HbA ( 1c ) ) level over the follow-up period preceding each event . Intensive treatment was most effective when begun early , before complications were detectable . These risk reductions , achieved at a median HbA ( 1c ) level difference of 9.1 % for conventional treatment vs 7.3 % for intensive treatment have been maintained through 7 years of EDIC , even though the difference in mean HbA ( 1c ) levels of the 2 former randomized treatment groups was only 0.4 % at 1 year ( P < .001 ) ( 8.3 % in the former conventional treatment group vs 7.9 % in the former intensive treatment group ) , continued to narrow , and became statistically nonsignificant by 5 years ( 8.1 % vs 8.2 % , P =.09 ) . The further rate of progression of complications from their levels at the end of the DCCT remains less in the former intensive treatment group . Thus , the benefits of 6.5 years of intensive treatment extend well beyond the period of its most intensive implementation . Intensive treatment should be started as soon as is safely possible after the onset of type 1 diabetes mellitus and maintained thereafter , aiming for a practicable target HbA ( 1c ) level of 7.0 % or less .
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Intervention_Physical
intensive therapy
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Intervention_Physical
intensive treatment
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Intervention_Physical
intensive treatment
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Intervention_Physical
Intensive treatment
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Intervention_Physical
intensive treatment
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Intervention_Physical
intensive treatment
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Intervention_Physical
intensive treatment
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Intervention_Physical
Intensive treatment
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Outcome_Physical
microvascular complications
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Outcome_Physical
microvascular complications
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Outcome_Physical
retinopathy
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Outcome_Physical
nephropathy
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Outcome_Physical
neuropathy
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Outcome_Physical
retinopathy
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Outcome_Physical
nephropathy
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Outcome_Physical
mean glycosylated hemoglobin ( HbA ( 1c ) ) level
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Outcome_Physical
median HbA ( 1c ) level
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Outcome_Physical
difference in mean HbA ( 1c ) levels
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Outcome_Physical
rate of progression of complications
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Outcome_Physical
target HbA ( 1c ) level
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Participant_Condition
type 1 diabetes mellitus
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Participant_Condition
type 1 diabetes mellitus