P. Reichard et M. Pihl, MORTALITY AND TREATMENT SIDE-EFFECTS DURING LONG-TERM INTENSIFIED CONVENTIONAL INSULIN-TREATMENT IN THE STOCKHOLM DIABETES INTERVENTION STUDY, Diabetes, 43(2), 1994, pp. 313-317
Citations number
25
Categorie Soggetti
Endocrynology & Metabolism","Medicine, General & Internal
Altogether, 102 patients were randomized to intensified conventional t
reatment (ICT) (n = 48) or standard treatment (ST) (n = 54). After 7.5
years, 89 patients remained, and it was shown that microangiopathy wa
s retarded by the lower blood glucose concentrations seen in the patie
nts in the ICT group. HbA(1c) was reduced from (means +/- SE) 9.5 +/-
0.2% to 7.1 +/- 0.1% in the ICT group and from 9.4 +/- 0.2% to 8.5 +/-
0.1% in the ST group (P < 0.001). Of the patients, 4 in the ICT group
and 3 in the ST group died. Mortality was predicted by albuminuria, t
he amplitude of the sural nerve action potential, and the test of arm
blood flow during contraction of the contralateral hand (sympathetic n
erve function) at baseline (P < 0.05). Weight increased by 4.4 +/- 1.1
kg in the ICT group and 1.8 +/- 0.7 kg in the ST group (P 0.05). Athe
rosclerosis, measured with digital pulse plethysmography, was approxim
ately the same in the groups at baseline and after five years. In each
group, 3 patients had myocardial infarctions, and 2 from each group h
ad ketoacidosis once. There was a mean of 1.1 episodes per patient and
per year of serious hypoglycemia in the ICT group and 0.4 episodes pe
r patient and per year in the ST group. No adverse incidents or accide
nts were observed in either group, and there were no differences betwe
en the groups with regard to cognitive function measured with a batter
y of tests. In conclusion, intensified diabetes treatment, which retar
ded the microvascular complications, caused some weight gain and an al
most threefold increase of the frequency of serious hypoglycemia, but
brain function did not deteriorate.