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DCCT/EDIC 30th Anniversary Summary Findings

Neuropathy and Related Findings in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study

  1. Catherine L. Martin1⇑,
  2. James W. Albers2,
  3. Rodica Pop-Busui1,
  4. for the DCCT/EDIC Research Group*
  1. 1Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan Medical School, Ann Arbor, MI
  2. 2Department of Neurology, University of Michigan Medical School, Ann Arbor, MI
  1. Corresponding author: Catherine L. Martin, martinc{at}med.umich.edu.
  1. C.L.M., J.W.A., and R.P.-B. contributed equally to this work.

Diabetes Care 2014 Jan; 37(1): 31-38. https://doi.org/10.2337/dc13-2114
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Abstract

OBJECTIVE To describe the development and progression of neuropathy and related findings among patients with type 1 diabetes who participated in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study.

RESEARCH DESIGN AND METHODS The main diabetic peripheral neuropathy (DPN) outcome was assessed using clinical symptoms, signs, and nerve conduction study results during DCCT and repeated in EDIC year 13/14. Cardiovascular autonomic neuropathy (CAN) was assessed by R-R response to paced breathing, Valsalva ratio, and blood pressure response to standing during DCCT and in EDIC years 13/14 and 16/17. Additionally, symptoms reflecting neuropathic pain and autonomic function (including hypoglycemia awareness) were collected yearly in EDIC using standardized questionnaires; peripheral neuropathy was also assessed annually using the Michigan Neuropathy Screening Instrument. Assessments of genitourinary function were collected at EDIC year 10.

RESULTS Intensive therapy during the DCCT significantly reduced the risk of DPN and CAN at DCCT closeout (64% and 45%, respectively, P < 0.01). The prevalence and incidence of DPN and CAN remained significantly lower in the DCCT intensive therapy group compared with the DCCT conventional therapy group through EDIC year 13/14.

CONCLUSIONS The persistent effects of prior intensive therapy on neuropathy measures through 14 years of EDIC largely mirror those observed for other diabetes complications. DCCT/EDIC provides important information on the influence of glycemic control, and the clinical course of diabetic neuropathy, and, most important, on how to prevent neuropathy in type 1 diabetes.

Footnotes

  • Clinical trial reg. nos. NCT00360815 and NCT00360893, clinicaltrials.gov.

  • ↵*A complete list of participants in the DCCT/EDIC Research Group can be found in N Engl J Med 2011;365:2366–2376.

  • See accompanying articles, pp. 5, 8, 9, 17, 24, 39, and 44.

  • Received September 7, 2013.
  • Accepted October 4, 2013.
  • © 2014 by the American Diabetes Association.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

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Neuropathy and Related Findings in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study
Catherine L. Martin, James W. Albers, Rodica Pop-Busui, for the DCCT/EDIC Research Group
Diabetes Care Jan 2014, 37 (1) 31-38; DOI: 10.2337/dc13-2114

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Neuropathy and Related Findings in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study
Catherine L. Martin, James W. Albers, Rodica Pop-Busui, for the DCCT/EDIC Research Group
Diabetes Care Jan 2014, 37 (1) 31-38; DOI: 10.2337/dc13-2114
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