The Diabetes Control and Complications Trial: Implications for children and adolescents

The highly publicised results of the Diabetes Control and Complications Trial (DCCT) released in 1993 confirmed conclusively that glycaemic control is a major contributor to the risk and progression of microvascular complications in insulin-dependent diabetes. Specifically, near normoglycaemia maintained for three to nine years reduced both the risk and the progression of retinopathy, nephropathy and neuropathy by 34%-76%.1 This was achieved with only a 1.8 % difference in mean levels of glycosylated haemoglobin (HbA1C) between the conventional and intensive treatment groups. The conventional treatment group maintained a mean HbA1C, level of 7.2%. Furthermore, there was a direct and continuous relationship between diabetes control and the risk of complications. The Australian Diabetes Society has presented a position statement in relation to these findings.2 More recently, a separate analysis of the adolescent sub-group aged 13-18 years was released. 3,4 This reported a similar reduction in complications risk in adolescents as well as a similar risk of adverse events in those receiving intensive therapy. However, there were differences between adolescents and adults in the DCCT in terms of their HBA1C levels, and incidence of hypoglycaemia in both conventional and intensive treatment groups. WHAT RELEVANCE DO THESE FINDINGS HAVE TO CHILDREN AND