COMPLICATIONS IN IDDM ARE CAUSED BY ELEVATED BLOOD-GLUCOSE LEVEL - THE STOCKHOLM DIABETES INTERVENTION STUDY (SDIS) AT 10-YEAR FOLLOW-UP

Blood glucose values close to normal reduce the microvascular complica tions of insulin-dependent diabetes mellitus. The Stockholm study of t his effect continued after the initial 7.5-year period in order to see what happened when intensively treated patients were left to control their own treatment while treatment was intensified in the control gro up. Forty-three patients with insulin-dependent diabetes randomised to intensified conventional treatment (ICT) and 48 patients randomised t o standard treatment (ST) were followed-up for 10 years. Vascular comp lications, treatment side-effects and well-being were studied. Risk fa ctors for complications were sought. HbA(1c) (normal range 3.9-5.7 %) was reduced from 9.5 +/- 1.4 % (mean +/- SD) in the ICT group and 9.4 +/- 1.2% in the ST group to a mean (during 10 years) of 7.2 +/- 0.6 % and 8.3 +/- 1.0 %, respectively (p < 0.001). Serious retinopathy (63 v s 33%, p = 0.003), nephropathy (26 vs 7 %, p = 0.012) and symptoms of neuropathy (32 vs 14%, p = 0.041) were more common in the ST group aft er 10 years. HbA(1c) and age were the only risk factors for complicati ons. Self-reported well-being increased to a greater degree and severe hypoglycaemia was more common in the ICT group. Cognitive function af ter 10 years was similar in both treatment groups, and was not related to the number of severe hypoglycaemic episodes. Intensified insulin t reatment leads to reduced long-term complications and increased well-b eing without causing undue side-effects.