Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial
Abstract
The Diabetes Control and Complications Trial has demonstrated that intensive diabetes treatment delays the onset and slows the progression of diabetic complications in subjects with insulin-dependent diabetes mellitus from 13 to 39 years of age. We examined whether the effects of such treatment also occurred in the subset of young diabetic subjects (13 to 17 years of age at entry) in the Diabetes Control and Complications Trial. One hundred twenty-five adolescent subjects with insulin-dependent diabetes mellitus but with no retinopathy at baseline (primary prevention cohort) and 70 adolescent subjects with mild retinopathy (secondary intervention cohort) were randomly assigned to receive either (1) intensive therapy with an external insulin pump or at least three daily insulin injections, together with frequent daily blood-glucose monitoring, or (2) conventional therapy with one or two daily insulin injections and once-daily monitoring. Subjects were followed for a mean of 7.4 years (4 to 9 years). In the primary prevention cohort, intensive therapy decreased the risk of having retinopathy by 53% (95% confidence interval: 1% to 78%; p = 0.048) in comparison with conventional therapy. In the secondary intervention cohort, intensive therapy decreased the risk of retinopathy progression by 70% (95% confidence interval: 25% to 88%; p = 0.010) and the occurrence of microalbuminuria by 55% (95% confidence interval: 3% to 79%; p = 0.042). Motor and sensory nerve conduction velocities were faster in intensively treated subjects. The major adverse event with intensive therapy was a nearly threefold increase of severe hypoglycemia. We conclude that intensive therapy effectively delays the onset and slows the progression of diabetic retinopathy and nephropathy when initiated in adolescent subjects; the benefits outweigh the increased risk of hypoglycemia that accompanies such treatment.
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These stresses collectively lead to higher glucose levels.
“These stresses collectively lead to higher glucose levels [8–10].”
This care gap is a major source of health disparity, with racial and ethnic minorities, and under-resourced communities, having worse outcomes, and a disproportionately higher prevalence of DED.
“This care gap is a major source of health disparity, with racial and ethnic minorities, and under-resourced communities, having worse outcomes, and a disproportionately higher prevalence of DED2,5–9.”
From Autonomous artificial intelligence increases screening and follow-up for diabetic retinopathy in youth: the ACCESS randomized control trial (2024) · cites this paper as [6]
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Karges, B., Kapellen, T., Wagner, V. M., Steigleder-Schweiger, C., Karges, W., Holl, R. W., Rosenbauer, J., & Initiative, F. T. D. (2017) · Pediatric Diabetes · doi:10.1111/pedi.12348 · Cited by 58 · see citing works
McTavish, L., & Wiltshire, E. (2011) · Pediatric Diabetes · doi:10.1111/j.1399-5448.2010.00725.x · Cited by 58 · see citing works
Berghaeuser, M., Kapellen, T., Heidtmann, B., Haberland, H., Klinkert, C., Holl, R., & for the DPV-Science-Initiative and the German working group for insulin pump treatment in paediatric patients (2008) · Pediatric Diabetes · doi:10.1111/j.1399-5448.2008.00416.x · Cited by 58 · see citing works
Metformin added to insulin therapy for type 1 diabetes mellitus in adolescents
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Bionic Pancreas Research Group, Messer, L. H., Buckingham, B. A., Cogen, F., Daniels, M., Forlenza, G., Jafri, R. Z., Mauras, N., Muir, A., Wadwa, R. P., et al. (2022) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2022.0201.pub · Cited by 59 · see citing works
Real-world evidence of automated insulin delivery system use
Considine, E. G., & Sherr, J. L. (2024) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2023.0442 · Cited by 59 · see citing works
Continuous subcutaneous insulin infusion: practical issues
Saboo, B., & Talaviya, P. (2012) · Indian Journal of Endocrinology and Metabolism · doi:10.4103/2230-8210.104055 · Cited by 32 · see citing works
Wadwa, R. P., Laffel, L. M., Franco, D. R., Dellva, M. A., Knights, A. W., & Pollom, R. K. (2023) · Diabetes, Obesity and Metabolism · doi:10.1111/dom.14849 · Cited by 24 · see citing works
Lower A1c among adolescents with lower perceived A1c goal: a cross-sectional survey
Clements, S. A., Anger, M. D., Bishop, F. K., McFann, K. K., Klingensmith, G. J., Maahs, D. M., & Wadwa, R. P. (2013) · International Journal of Pediatric Endocrinology · doi:10.1186/1687-9856-2013-17 · Cited by 19 · see citing works
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“These stresses collectively lead to higher glucose levels [8–10].”
BackgroundLega, I. C., Yale, J.-F., Chadha, A., Paty, B., Roscoe, R., Snider, M., Steier, J., Bajaj, H. S., Barnes, T., Gilbert, J., et al. (2023) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2023.08.003 · Cited by 12 · see citing works
Potential approaches to prevent hypoglycemia-associated autonomic failure
Lontchi-Yimagou, E., You, J. Y., Carey, M., Gabriely, I., Shamoon, H., & Hawkins, M. (2018) · Journal of Investigative Medicine · doi:10.1136/jim-2017-000582 · Cited by 12 · see citing works
- Venue
- The Journal of Pediatrics
- Publisher
- Elsevier BV
- Published
- 1994-08
- Volume
- 125
- Issue
- 2
- Pages
- 177-188
- ISSN
- 0022-3476 (ISSN-L)
- OpenAlex
- W52391068
- Cited by
- 1,654
- References
- 46
- Citations by year
- 2026: 21 · 2025: 28 · 2024: 43 · 2023: 51 · 2022: 70 · 2021: 51 · 2020: 47 · 2019: 47 · 2018: 58 · 2017: 54 · 2016: 62 · 2015: 70 · 2014: 76 · 2013: 82 · 2012: 70
- FWCI
- 11.44
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Pediatrics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- intensive diabetes treatment, type 1 diabetes, adolescents, diabetic retinopathy, diabetic nephropathy, microalbuminuria, glycemic control, insulin pump, multiple daily insulin injections, blood glucose monitoring, hypoglycemia, nerve conduction velocity, diabetes complications
- MeSH terms
- Adolescent, Diabetes Mellitus, Type 1, Diabetic Nephropathies, Diabetic Retinopathy, Drug Administration Schedule, Female, Humans, Hypoglycemia, Insulin, Insulin Infusion Systems, Male, Primary Prevention, Prospective Studies, Blood Glucose Self-Monitoring, Body Mass Index, Treatment Outcome
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