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Cited by 350Diabetes Management and ResearchPain Mechanisms and TreatmentsDiabetic Foot Ulcer Assessment and Management

Neuropathy among the diabetes control and complications trial cohort 8 years after trial completion

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Martin, Catherine L., Albers, James, Herman, William H., Cleary, Patricia, Waberski, Barbara, Greene, Douglas A., Stevens, Martin J., Feldman, Eva L.·2006·Diabetes Care
DOI 10.2337/diacare.29.02.06.dc05-1549PMC PMC2622720
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Abstract

OBJECTIVE—To evaluate the impact of prior intensive diabetes therapy on neuropathy among former Diabetes Control and Complications Trial (DCCT) participants. RESEARCH DESIGN AND METHODS—At the conclusion of the DCCT, subjects in the intensive group were encouraged to maintain intensive therapy, and subjects in the conventional group were encouraged to begin intensive therapy. Thereafter, we annually assessed neuropathy as part of the Epidemiology of Diabetes Intervention and Complications (EDIC) study. Neuropathy was defined using the Michigan Neuropathy Screening Instrument (MNSI). We recorded potential adverse consequences of neuropathy. RESULTS—At the first EDIC examination, 1,257 subjects participated in the neuropathy assessment. Consistent with DCCT results, the former intensive group showed a lower prevalence of neuropathy than the conventional group based on positive questionnaire (1.8 vs. 4.7%; P = 0.003) or examination (17.8 vs. 28.0%; P < 0.0001) results. Despite similar levels of glycemic control, symptoms and signs of neuropathy remained less prevalent among the former intensive group compared with the conventional group. At the beginning of the EDIC study, prior intensive therapy reduced the odds of having symptoms and signs of neuropathy using MNSI criteria by 64% (P = 0.0044) and 45% (P < 0.0001), respectively, with similar odds reductions observed for both neuropathic symptoms (51%, P < 0.0001) and neuropathic signs (43%, P < 0.0001) across 8 years of EDIC follow-up. CONCLUSIONS—The benefits of 6.5 years of intensive therapy on neuropathy status extended for at least 8 years beyond the end of the DCCT, similar to the findings described for diabetic retinopathy and nephropathy.

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  • Subsequent observational data from long-term follow-up after termination of randomization periods of both the DCCT and UKPDS cohorts showed a persistence of significant microvascular benefits and also demonstrated an emergence of beneficial effect on CV outcomes attributed to intensive glycemic control (metabolic memory or legacy effect).

    “Subsequent observational data from long-term follow up after termination of randomization periods of both the DCCT and UKPDS cohorts showed a persistence of significant microvascular benefits and also demonstrated an emergence of beneficial effect on CV outcomes attributed to intensive glycemic control.This has been termed as”

    From Targets for Glycemic Control (2018) · cites this paper as [15]

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  • Follow-up of the DCCT cohorts in the Epidemiology of Diabetes Interventions and Complications (EDIC) study has shown persistence of the effect of intensive glycemic control in previously intensively treated subjects, even though their glycemic control has been equivalent to that of previous standard arm subjects during follow-up.

    “Follow-up of the DCCT cohorts in the Epidemiology of Diabetes Interventions and Complications (EDIC) study has shown persistence of this effect in previously intensively treated subjects, even though their glycemic control has been equivalent to that of previous standard arm subjects during follow-up (46,47).”

    From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [47]

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Authors
Martin, C. L., Albers, J., Herman, W. H., Cleary, P., Waberski, B., Greene, D. A., Stevens, M. J., & Feldman, E. L.
Affiliations
Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Intervention and Complications (EDIC) Research Group
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2006-02-01
Volume
29
Issue
2
Pages
340-344
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/diacare.29.02.06.dc05-1549
PMC
PMC2622720
OpenAlex
W2010740931
Cited by
350
References
15
Citations by year
2026: 4 · 2025: 2 · 2024: 6 · 2023: 14 · 2022: 7 · 2021: 8 · 2020: 14 · 2019: 11 · 2018: 16 · 2017: 16 · 2016: 17 · 2015: 19 · 2014: 30 · 2013: 26 · 2012: 22
FWCI
20.92
Type
journal article
Language
en
Open access
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
Funders
  • Eli Lilly and Company
  • National Institutes of Health (n01dk062204-003)
  • National Institute of Diabetes and Digestive and Kidney Diseases (N01 DK062204)
  • National Center for Research Resources
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
Keywords
diabetic neuropathy, intensive diabetes therapy, Diabetes Control and Complications Trial, Michigan Neuropathy Screening Instrument, glycemic control, long-term follow-up, type 1 diabetes
MeSH terms
Diabetes Mellitus, Type 1, Diabetic Neuropathies, Follow-Up Studies, Health Surveys, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Insulin, Surveys and Questionnaires

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