Confronting Diabetes
Sample Chapter:

The Diabetes Control and Complications Trial
(The "DCCT")

The National Institutes of Health in the United States conducted a study (called a "trial") of 1441 people with Type I diabetes, which lasted ten years. The 1441 people who participated in the trial were from 29 different medical centers around the US and Canada. Their "trial" ended in 1993, and the conclusions they drew were very important to anyone with diabetes, whether they have Type I or Type II diabetes.

This Diabetes Control and Complications Trial (called the "DCCT") showed conclusively and very scientifically that aggressively, intensively managing one's blood glucose level to keep it as near to "normal" as possible can prevent the development and slow the progression of the complications of diabetes dramatically.

The 1441 people in the trial were randomly assigned to two groups, each group getting about half of the people. The first group of people received "normal", conventional treatment for their diabetes. They used the same regimen followed by the majority of people with Type I diabetes--they took one or two insulin injections a day, did daily self-monitoring of their blood glucose, and had a program of diabetes education that included nutritional instruction. They visited their clinic every three months.

The second group, however, received a more intensive kind of care. The people in that second group were cared for by an experienced team including a nurse, a dietitian and a diabetologist, among others. They received intensive diabetes education and nutritional instruction, were monitored by telephone every week and visited their clinic monthly. They checked their blood glucose four or more times a day and injected insulin three or more times a day (or used an insulin pump). They adjusted their own insulin dosages. (These people were confronting and controlling their diabetes--with a vengeance!)

At the end of ten years of this, you might ask, what was the difference in the two groups?

A person in the intensively managed group was 40% to 75% less likely to have gotten the complications of diabetic retinopathy, neuropathy (nerve disease), and nephropathy (kidney disease).

With regard to their blood glucose levels, the people in the second group were able to average 155 mg/dL, and averaged a glyco hemoglobin level of about 7.2%.

The people in the first, conventional treatment group averaged blood glucose levels of 231 mg/dL, and averaged a glyco hemoglobin level of 9.0%. (They weren't being pressured to confront their diabetes as often or control it as well as the second group.)

This is a good place to remember that it is the extra, unneeded glucose in the blood stream, unconfronted and uncontrolled over the long haul, which apparently causes the complications of diabetes to appear or worsen.

The core message of the DCCT, as they put it, is "Metabolic Control Matters!" They say that if near normal control is not feasible, then improved control should be the goal. Although the people they tested were all insulin-dependent, the people at the CDC (Center for Disease Control) feel it is "reasonable to anticipate that better glucose control would also benefit persons" with Type II diabetes.

So what does this mean to you if you have diabetes? Excellent confront and control of your diabetes can cut your chance of getting the complications of diabetes in half. It shows that the level of confront makes a difference. That is terrific news if you have diabetes and confront and control it--and completely useless information if you have diabetes and fail to confront it and control it.

(If you don't have diabetes, it is still great news!)

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Other Chapters:

  • Diabetes - The Energy Disease

  • Diabetes in America - The Big Statistical Picture

  • Interviews of People with Diabetes

  • Competence

  • What is Circulation?

  • Nerves

  • Interviews of Diabetes Educators

  • To the Health Care Professional

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