THE EFFECT OF INTENSIVE DIABETES TREATMENT ON THE PROGRESSION OF DIABETIC-RETINOPATHY IN INSULIN-DEPENDENT DIABETES-MELLITUS - THE DIABETESCONTROL AND COMPLICATIONS TRIAL

Authors
SHAMOON H DUFFY H FLEISCHER N ENGEL S SAENGER P STRELYZN M LITWAK M WYLIEROSETT J FARKASH A GEIGER D ENGEL H FLEISCHMAN J POMPI D GINSBERG N GLOVER M BRISMAN M WALKER E THOMASUNIS A GONZALEZ J GENUTH S DAHMS W BROWN E PUGSLEY P MAYER L KERR D LANDAU B SINGERMAN L RICE T NOVAK M SMITHBREWER S MCCONNELL J DROTAR D WOODS D LITVENE M KATIRJI B BROWN C CAMPBELL R RICHARDSON M LACKAYE M LEVY B CHANG S HEINHEINEMANN M BARRON S ASTOR L LEBECK D BRILLON D DIAMOND B VASILASDWOSKIN A BRISMAN M LAURENZI B FOLDI N RUBIN M WHITEHOUSE F KAHKONEN D KRUGER D FACHNIE J FISK J CAREY J COX M AHMAD B ANGUS E CAMPBELL H FIELDS D CROSWELL M BASHA K CHUNG P SCHOENHERR A MARCHIORI K MOBLEY M FRANCIS J KELLY J ETZWILER D HOLLANDER P CALLAHAN P CASTLE G BERGENSTAL R SPENCER M NELSON J BEZECNEY L ROETHKE C ORBAN A JACOBSEN A CROWELL S WOLFSDORF J BEASER R GANDA O ROZENSWIEG J STEWART C HALFORD B FRIEDLANDER E TARSY D ARRIGG P SHARUK G SHAH S WU G CAVALLERANO J POOLE R CAVICCHI R FLEMING D MARCUS J GRIFFITHS C CAPPELLA N NATHAN D LARKIN M GODINE J BRINK S NORMAN D MCKITRICK C DELAHANTY L ANDERSON E LOU P TAYLOR C CROS D LYNCH J MEINKES D FOLINO K LYON R SCHMIDT A RIZZA R ZIMMERMAN B SCHWENK W MORTENSON J ZIEGLER G LUCAS A HANSON N PACH J WOODWICK R TACKMANN R SUAREZ G LEBARRON K SHUMANN M LIEN M COLWELL J MAYFIELD R PICKETT J WOOD D CHITWOOD M BILLINGS D DABNEY Y BUSE J KING L VALE S THOMPSON T BOHM B LYONS T HERMAYER K RICE A MOLITCH M SCHAEFER B JOHNSON C LYONS J METZGER B COHEN B NISHIDA T PARQUE K YUSIM V MOORE M DINEEN K STAHL J RICHINE L WEINBERG D LOOSE I KUSHNER M JAMPOL L MORRISON A TILDESLEY H JALBERT A LEUNG S BEGG I JOHNSON D KENNEDY T MEADOWS G KOLTERMAN O LORENZI G JONES K GOLDBAUM M GRANT I SWENSON M REED R KADLEC K GIOTTA M LYON R KIRSCH L ZIETLER R SIVITZ W SCHROTT H HOFFMAN R MACINDOE J KRAMER J BAYLESS M OLSON N TINDAL B SNETSELAAR L MUELLER D SWARTZENDRUBER A KOWARSKI A LEVIN P OSTROWSKI D YOUNGHYMAN D CHALEW S BARLOW M HYLTON J LAKHANPAL V ELMAN M BUIE W BLUM S WEINER B MACE B MILLAR M GREENE D FLOYD J MARTIN C BENNETT S LASICHAK A VINE A ALBERS J SANDFORD T LOFTIN J STEVENS M ELNER S DUNN F HENRY D BANTLE J BALLES M KENNEDY W KHAN M MECH M OLSON J KWONG C MCKENZIE L RAMSAY R WARHOL R ROBINER W KNOBLOCK W GOLDSTEIN D HALL M BURNS T KLACHKO D GIANGIACOMO J RAWLINGS S ASTON L ENGLAND J WIEDMEYER H DAUGHERTY M LIGHTFOOT M WILSON R WILSON R BLINDER K GASH L GARDNER D GRIFFING G BROWNLEEDUFFECK M PALMER NR CONWAY R SCHADE D JOHANNES C REIDY R BICKNELL J VOGEL A DRUMM D JONES N BOYLE P CANADY J NICKELL D CROFTON F BAKER L ILVESCORRESSEL P SCHWARTZ S BRAUNSTEIN S MCBRIDE J BRUCKER A RENDLE L BROWN M SLADKY J MASCHAKCAREY B LAWLEY D NYBERG W WEENEY L SANDBURG E BYRD S AGUADO E MULHOLLAND N CAHN D SUSCAVAGE M DRASH A WESCHE J BRATKOWSKI M BECKER D ARSLANIAN S DOFT B FINEGOLD D LOBES L RINKOFF J WARNICKI J CURTIN D STEINBERG D VAGSTAD G RYAN C HARRIS F STERANCHAK L ARCH J KELLY K OLSEN K OSTROSKA P GUILIANI M GOOD M WILLIAMS T CAMPBELL A SHIPE C FLAVIA P CONWIT R MALONE J MCMILLIAN D GROVE N BABIONE L DECLUE T PAVAN P KORTHALS J SOLE H MANGIONE A KITABCHI A TAYLOR L BERTORINI T BURGHEN G FISHER J HUGHES T LINN J MEYER D MURPHY W JUSTICE M SHERMAN A WRIGHT L MURPHY L RICKS H RASKIN P STROWIG S BASCO M CERCONE S RAMIREZ L ANAND R WILSON C GREENLEE R ZINMAN B BARNIE A EHRLICH R DANEMAN D PERLMAN K LEITER L DEVENYI R MORTIMER C GORDON A FERGUSON R CAMELON K SIMKIN S LITTLEFIELD C RODIN G HARTLEY K KWAN J GNANAPANDITHEN D ROGERS S MCLEAN S MACKEEN L MILLER C MANDELCORN M NELLIS P RUTTAN L WILSONSMITH D PALMER J GINSBERG J KINYOUN J DOERR H MAUSETH R SWEENEY K OTTINGHAM L THOMSON L GREENBAUM C SAMESHIMA I HIRSCH I FARKASHIRSCH R ROSENBAUM G RUBNER N BROWN T KRAFT G BROECKEL J KARLSEN M KHAKPOUR D RAMIREZ M DUPRE J RODGER N COLBY P HRAMIAK I JENNER M CANNY C BROWN W SMITH T HARTH J BONDY S BEATH S MCCABE S GOUCHIE C LORENZ R LIPPS J MCRAE J MAY J MAY M CAMPBELL P FEMAN S KILROY A PULLIAM C SCHLUNDT D JANNASCH K DAVIS D SANTIAGO J WHITE N LEVANDOSKI L MCGILL J BUBB J OLK R NOETZEL M BONIUK I GRAND M KACIZAK R ORT E NOBEL G BODNAR J DAHL J BILYEU P THOMAS M BLANK J SCHMIDT L STRASSBURG Y WALTERS C WILLIAMS D RODRIGUEZ P ERICKSON M HEDRICK S BREEDING L HOFFMEYER G TAMBORLANE W AHERN J SHERWIN R GATCOMB P STOESSEL K HELD N EBERSOLE J SCANLON I CROFFORD O LACHIN J CLEARY P THOMPSON D KENNY D LAN S LAN G BRENNEMAN A OWEN W BACKLUND J ADAMS K ARNOLD D CAMPANELL R LORING N SCHEIRER P BECKER D JANIFER N LAMAS D DUNEGAN C ATLURI H WILLIAMS C ABDULBAAQIY S PAKALAPATI S YALAMANCHILI V HO S FRIEDMAN R MCNANEY B GIVENS J COLACO Y JENIFER M OSBORNE R ZELL V YOUNG J SIEBERT C BEVERLY D SHORES S STECKLEIN L PIKE T PFEIFFER M SCHUMER M MORAN M FARQUHAR J DAVIS M HUBBARD L MAGLI Y THOMAS S ONOFREY J JENSEN K BROTHERS R ANSAY S ARMSTRONG J BADAL D VANDERHOOFYOUNG M ESSER B
Citation
H. Shamoon et al., THE EFFECT OF INTENSIVE DIABETES TREATMENT ON THE PROGRESSION OF DIABETIC-RETINOPATHY IN INSULIN-DEPENDENT DIABETES-MELLITUS - THE DIABETESCONTROL AND COMPLICATIONS TRIAL, Archives of ophthalmology, 113(1), 1995, pp. 36-51
Citations number
21
Categorie Soggetti
Ophthalmology
Journal title
Archives of ophthalmology → ACNP
ISSN journal
00039950
Volume
113
Issue
1
Year of publication
1995
Pages
36 - 51
Database
ISI
SICI code
0003-9950(1995)113:1<36:TEOIDT>2.0.ZU;2-2
Abstract
Objective: To determine the magnitude of the decrease in the risk of r etinopathy progression observed with intensive treatment and its relat ionship to baseline retinopathy severity and duration of follow-up. De sign: Randomized clinical trial, with 3 to 9 years of follow-up. Setti ng and Patients: Between 1983 and 1989, 29 centers enrolled 1441 patie nts with insulin-dependent diabetes mellitus aged 13 to 39 years, incl uding 726 patients with no retinopathy and a duration of diabetes of 1 to 5 years (primary prevention cohort) and 715 patients with very mil d to moderate nonproliferative diabetic retinopathy and a duration of diabetes of 1 to 15 years (secondary intervention cohort). Ninety-five percent of all scheduled examinations were completed. Interventions: Intensive treatment consisted of the administration of insulin at leas t three times a day by injection or pump, with doses adjusted based on self-blood glucose monitoring and with the goal of normoglycemia. Con ventional treatment consisted of one or two daily insulin injections. Outcome Measures: Change between baseline and follow-up visits on the Early Treatment Diabetic Retinopathy Study retinopathy severity scale, assessed with masked gradings of stereoscopic color fundus photograph s obtained every 6 months. Results: Cumulative 8.5-year rates of retin opathy progression by three or more steps at two consecutive visits we re 54.1% with conventional treatment and 11.5% with intensive treatmen t in the primary prevention cohort and 49.2% and 17.1% in the secondar y intervention cohort. At the 6- and 12-month visits, a small adverse effect of intensive treatment was noted (''early worsening''), followe d by a beneficial effect that increased in magnitude with time. Beyond 3.5 years of follow-up, the risk of progression was five or more time s lower with intensive treatment than With conventional treatment. Onc e progression occurred, subsequent recovery was at lease two times mor e likely with intensive treatment than with conventional treatment. Tr eatment effects were similar in all baseline retinopathy severity subg roups. Conclusion: The results of the Diabetes Control and Complicatio ns Trial strongly support the recommendation that most patients with i nsulin-dependent diabetes mellitus use intensive treatment, aiming for levels of glycemia as close to the nondiabetic range as is safely pos sible.