DCCT

MCE, American Association of Clinical Endocrinologists ACE, American College of Endocrinology ADA, American Diabetes Association DCCT, Diabetes Control and Complications Trial. 

Referenced to a nondiabetic range of 4-6% using a DCCT-based assay. More stringent glycemic goals (i.e., a normal A1C,<6%) may further reduce complications at the cost of increased risk of hypoglycemia (particularly in those with type 1 diabetes). 

The Diabetes Control and Complications Trial (DCCT), the Stockholm Diabetes Intervention Study (DIS), the United Kingdom Prospective Diabetes Study (UKPDS), and the Japanese Kumamoto study show unequivocally that vigorous treatment of diabetes can decrease both the morbidity and mortality of the disease by reducing chronic complications. 

Results of the DCCT in type 1 diabetes showed that improving glycaemia with intensive insulin treatment delayed the onset and slow the progression of microvascular complications, such as retinopathy, neuropathy and nephropathy. 

Santanicllo Ponli Manzocchi Tetrahedron Lett. 1980, 21. 2655. For other methods of accomplishing this and similar conversions, see Cohen Song Fagcr Dccts./. Am. Chem. Soc. 1967, 89, 4%8 Wasscrman Lipshutz Tetrahedron Leu. 1975, 4611 Kabcria Vickcrv J. Chem. Soc., Chem. Commun. 1978, 459 Doleschall Toth Tetrahedron 1980, 36. 1649. 

The most frequent complication of insulin therapy is inadvertent hypoglycemia (21-23). Over 5% of deaths in diabetes can be attributed to hypoglycemia. The frequency increases with rigorous maintenance of normogly-cemia (24,25). In the Diabetes Control and Complications Trial (DCCT) (26) the frequency of serious hypoglycemia was more than three times increased in the intensively treated group, and the frequency of the attacks was related to the concentration of HbAlc (27). The UK Prospective Diabetes Study in patients with type 2 diabetes also showed an increased risk of hypoglycemia with more intensive treatment (28). 

In a meta-analysis of the metabolic and psychosocial impact of pumps, 52 studies were found 22 were published before 1987 and 13 after 1993, the year in which the results of the DCCT were published (225). The authors stated that therefore conclusions about efficacy are not definitive. All pump malfunctions were reported before 1988. All types of changes were reported when the frequency and severity of hypoglycemia were compared with prepump times. Infection and skin irritation were expressed in different ways in the various studies. The risk of diabetic ketoacidosis fell after 1993. Most users preferred to continue pump treatment, mainly because of more flexibility, greater freedom, and improved glycemic control. 

The DCCT Research Group. 1993. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329 977. 

A long-term randomized prospective study involving 1441 type 1 patients in 29 medical centers reported in 1993 that "near normalization" of blood glucose resulted in a delay in onset and a major slowing of progression of microvascular and neuropathic complications of diabetes during followup periods of up to 10 years (Diabetes Control and Complications Trial [DCCT] Research Group,... 

The National Glycohemoglobin Standardization Program (NGSP) used the CRMLN model to establish a reference laboratory network to standardize glycated hemoglobin (i.e., HbAlc) [33, 34], The purpose of the NGSP is to standardize HbAlc so that clinical laboratory results are comparable to the Diabetes Control and Complications Trial (DCCT) where relationships were established to mean blood glucose and risk for vascular complications. 

Intensive pharmacologic treatment of diabetes is known to decrease the risk for microvascular events such as nephropathy and retinopathy, but there is less evidence that it decreases macrovascular disease (28,29). DCCT/EDIC trial, however, demonstrated reduction in CVD (nonfatal Ml, stroke, death from CVD, confirmed angina, or the need for coronary-artery revascularization) in patients with type I diabetes assigned to intensive diabetes treatment compared with conventional treatment by 42% (p = 0.02) (30). Patients with lower extremity PAD and both type I and type 2 diabetes should be treated to reduce their glycosylated hemoglobin (Hb AIC) to less than 7%, per the American Diabetes Association recommendation (31). Subanalysis of the UKPDS showed no evidence of a threshold effect of Hb AIC a I % reduction in Hb Al C was associated with a 35% reduction in microvascular endpoints, an 18% reduction in Ml, and a 17% reduction in all-cause mortality. Frequent foot inspection by patients and physicians will enable early identification of foot lesions and ulcerations and facilitate prompt referral for treatment (32). 

Nathan DM, Cleary PA, Backlund JY et al. Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group. Intensive diabetes treatment and cardiovascular disease in patients with type I diabetes. N Engl J Med 2005 353(25) 2643-2653. 

Diabetic microvascular disease Near-normalization of blood glucose Prevented/delayed retinopathy, nephropathy, neuropathy DCCT >1,400 17... 

The Diabetes Control and Complications Trial (DCCT) has shown that intensified diabetes therapy resulted in HbAlc reductions of approximately 2% compared to conventional therapy, and that patients practicing intensified diabetes therapy enjoyed significant reductions in the feared microvascular complications of diabetes (DCCT Research Group, 1993). As such, the current aim of diabetes therapy is to achieve glycemic control that is as close to normal as possible while maintaining an acceptable quality of life for those patients for whom the therapy is prescribed.The DCCT also demon-... 

The Diabetes Control and Complications Trial (DCCT) Group (1994) demonstrated that tight control and management of blood glucose levels decreases the risks of complications both in terms of microvascular (retinopathy and renal failure) and macrovascular (stroke, angina, myocardial infarction) complications. 

Association DCCT, Diabetes Controi and Complications Trial. 

Groul) 1 is IFCC calihiated Gi oup 2 is DCCT aligned Group 3 is non-aligned by choice... 

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