Intensive therapy significantly reduced the risk of diabetic peripheral neuropathy by 64% and cardiovascular autonomic neuropathy by 45% compared with conventional therapy (P < 0.01).
Cohort
Does intensive glycemic therapy reduce the long-term risk of diabetic peripheral and cardiovascular autonomic neuropathy in patients with type 1 diabetes?
Intensive glycemic control in type 1 diabetes provides a persistent, long-term legacy effect that significantly reduces the risk of developing peripheral and cardiovascular autonomic neuropathy.
Estimación del efecto: Risk reduction 64% (DPN) and 45% (CAN)
valor p: p=< 0.01
OBJECTIVE To describe the development and progression of neuropathy and related findings among patients with type 1 diabetes who participated in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. RESEARCH DESIGN AND METHODS The main diabetic peripheral neuropathy (DPN) outcome was assessed using clinical symptoms, signs, and nerve conduction study results during DCCT and repeated in EDIC year 13/14. Cardiovascular autonomic neuropathy (CAN) was assessed by R-R response to paced breathing, Valsalva ratio, and blood pressure response to standing during DCCT and in EDIC years 13/14 and 16/17. Additionally, symptoms reflecting neuropathic pain and autonomic function (including hypoglycemia awareness) were collected yearly in EDIC using standardized questionnaires; peripheral neuropathy was also assessed annually using the Michigan Neuropathy Screening Instrument. Assessments of genitourinary function were collected at EDIC year 10. RESULTS Intensive therapy during the DCCT significantly reduced the risk of DPN and CAN at DCCT closeout (64% and 45%, respectively, P < 0.01). The prevalence and incidence of DPN and CAN remained significantly lower in the DCCT intensive therapy group compared with the DCCT conventional therapy group through EDIC year 13/14. CONCLUSIONS The persistent effects of prior intensive therapy on neuropathy measures through 14 years of EDIC largely mirror those observed for other diabetes complications. DCCT/EDIC provides important information on the influence of glycemic control, and the clinical course of diabetic neuropathy, and, most important, on how to prevent neuropathy in type 1 diabetes.
Martin et al. (Wed,) conducted a cohort in Type 1 diabetes. Intensive therapy vs. Conventional therapy was evaluated on Diabetic peripheral neuropathy (DPN) and cardiovascular autonomic neuropathy (CAN) (Risk reduction 64% (DPN) and 45% (CAN), p=< 0.01). Intensive therapy significantly reduced the risk of diabetic peripheral neuropathy by 64% and cardiovascular autonomic neuropathy by 45% compared with conventional therapy (P < 0.01).