DCCT and intensive insulin therapy - abstract

ABSTRACT

In June 1993, the Diabetes Control and Complications Trial (DCCT) Group announced their long-awaited research findings to the world. In this landmark study in patients with insulin-dependent diabetes mellitus (IDDM), the question "Does control of hyperglycaemia lead to primary and secondary prevention of diabetic retinopathy, nephropathy and neuropathy?" was answered. The evidence presented clearly proved that the better the glycaemic control an IDDM patient had, the smaller was the risk of developing diabetic retinopathy, nephropathy and neuropathy (primary prevention). For those patients who already had these microanglopathies, the better the glycaemic control, the smaller was the risk of their progression (secondary prevention). There was a price to pay for this achievement - the tighter the glycaemic control, the greater was the risk of developing severe hypoglycaemia was about 3-fold in those patients who received intensive insulin therapy to attain tight glycaemic control compared with those who were on conventional insulin therapy whose glycaemia was not as well controlled. Intensive insulin therapy used to attained better glycaemia control consisted of multiple dose insulin injections or continuous subcutaneous insulin infusion. In humans, there are two components of insulin secretion - a "basal" component where insulin is secreted continuously 24 hours a day and a "bolus" component where extra insulin is secreted in response to meals. Intensive insulin therapy attempt to mimic this and, in so doing, improves glycaemic control when compared with conventional insulin therapy where two injections of mixed insulin are administered daily. Intensive insulin therapy is more than mimicking the physiological pattern of insulin secretion. Intensive insulin therapy is also enhancing adherence to therapy through goal setting, compassionate caring of, and regular communication with, the patients with IDDM. It is interdisciplinary team work, involving the Diabetes Health Care Team (physician, nurse educator, dietitian, etc.) and the patient(AU)