THE DCCT (DIABETES CONTROL AND COMPLICATIONS TRIAL) RESULTS
The massive test, financed by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), began back in 1983, at twenty-nine medical centers in the United States and Canada. A total of 1,441 people with Type I diabetes took part. Their average age at the start of the test was twenty-seven; the group was approximately half men and half women. Some of the test subjects had no signs of complications, but in others there were indications that eye disorders, kidney problems, nerve damage, or other complications were beginning to develop. Each person was assigned randomly to one of two groups.The first group (the controls) received the diabetes treatment that had been the standard for many years. The IDDM patients typically injected insulin once or twice a day, tested their blood sugar once a day, followed a planned program of diet (including three meals plus three snacks each day) and exercise, and were checked by medical professionals every two or three months.Patients in the second group (the experimentals) followed a much more aggressive approach to diabetes control. They monitored their blood sugar levels four to seven times a day and fine-tuned their insulin dosages either with three to five injections a day or by using an insulin pump that supplied a continuous flow of insulin into the body. They paid close attention to diet and exercise. The patients were helped by teams of nurses, dietitians, and doctors who called them on the phone at least once a week to check on how things were going and provide any needed advice. The experimental patients also visited a diabetes clinic each month.The study was intended to go on until 1994, but the results were so striking that the test was stopped a year early so that all people with diabetes could benefit from its findings. “The discovery of insulin was an absolute miracle; this study is in the ball park of comparison,” commented NIDDK director, Dr. Phillip Gordon.Comparisons of the two treatment groups indicated that the “tight-control” program decreased the development of eye problems by 76 percent, cut the rate of severe kidney problems by 35 to 56 percent, and decreased crippling nerve disorders by 60 percent.There were a few drawbacks. People on the tight-control regimen had about triple the risk of fainting as a result of an insulin reaction, compared to those on the conventional diabetes treatment. And the cost of treatment (typically about $1,500 to $2,000 a year on the conventional regimen) is doubled. But this short-term cost increase is far less than the long-term costs of treating the serious complications that the tight-control treatment can delay or prevent. And most people would say that the increased risk of a hypoglycemic reaction is well worth the benefit of a longer, healthier life.Does the tight-control regimen add to the burdens of coping with diabetes? Not really, says New Jersey diabetes specialist Dr. Richard Agrin. The aggressive approach has been used for years at the Diabetes Treatment Center at Somerset Medical Center, where he is the medical director. “Our experience is that patients have better control of their disease, and as a result, they also are happier and less anxious,” he says. “Aggressive treatment allows them to tailor their treatment to their life-styles instead of adjusting their life-styles to their need for insulin.”*29\268\2*
