From 1983 to 1993, the Diabetes Control and Complications Trial (DCCT) randomized 1,441 patients with type 1 diabetes to either conventional or intensive glycemic control. Conventional control meant taking one or two daily insulin injections, while intensive meant taking at least three daily injections of insulin and at least four blood glucose monitoring tests. The Epidemiology of Diabetes Interventions and Complications study (EDIC) was conducted as a follow-up to the DCCT and took place starting when DCCT ended; it is ongoing today.
A report published in the Archives of Internal Medicine on July 27, written by the DCCT Study Group and led by David M. Nathan, MD and collaborators analyzed data from the DCCT and EDIC trials (thus the name DCCT/EDIC) and showed dramatic improvements in outcomes for patients involved in the study compared with those who had been diagnosed just 10-20 years before. The outcomes from patients that have had diabetes for thirty (30!) years were presented and showed that patients in the intensive group had significantly fewer serious complications, namely proliferative retinopathy, nephropathy, and cardiovascular disease (CVD) compared to patients in the conventional group (when you see the word “significant” in scientific literature, you know it’s a big deal). "Now in the modern era, knowing how to use insulin more physiologically has led to really dramatically different outcomes,” said Dr. David Nathan of Mass General, a highly regarded endocrinologist and researcher and one of the study chairs for DCCT/EDIC.
This is hugely encouraging news and strong scientific evidence that the strides we’ve made in treating diabetes has made a huge difference. The data presented should also encourage patients with type 1 diabetes to strive for tight glycemic control – and today, we know it’s easier to do this with insulin pumps and CGM and therapies like rapid acting analogs and Symlin. While we know it can be hard in this economy to afford the latest and greatest therapies and technologies, this data may well be the evidence we need to get insurers to pay for more in the US. Although there are no conclusions yet for patients with type 2 diabetes, we will watch to see if the same conclusions can be made. A great day for people with diabetes – proving that our hard work in trying to stay in tight control does pay off!