Intensive Diabetes Therapy and GFR in Type 1 Diabetes
The DCCT/EDIC Research Group*
NEJM Nov 12, 2011
- Briefly, intensive therapy consisted of three or more injections of insulin daily or the use of an insulin pump, with the aim of achieving a glycated hemoglobin level of less than 6.05% (which was considered to be the upper limit of the normal range). The goal of conventional therapy was the prevention of symptoms of hyperglycemia and hypoglycemia with the use of one or two injections of insulin daily.
- The mean glycated hemoglobin level during the DCCT (1983 through 1993), time-averaged throughout the study, was 7.3% in the intensive-therapy group and 9.1% in the conventional-therapy group.
- The median follow-up period for the two studies combined was 22 years (interquartile range, 21 to 24). During this time, impairment of the GFR developed in 70 participants, of whom 24 had been assigned to DCCT intensive therapy and 46 to DCCT conventional therapy
- Our data suggest that giving approximately 29 persons with type 1 diabetes intensive diabetes therapy for 6.5 years prevents one case of an impaired GFR over a total follow-up period of 20 years.
- Moreover, along with congruent salutary effects on retinopathy, neuropathy, and cardiovascular disease, these effects reinforce current recommendations to target a glycated hemoglobin level of less than 7% in patients with type 1 diabetes.10,11