Washington University, St. Louis, Missouri, USA.
Diabetes. 2010 May;59(5):1244-53. doi: 10.2337/db09-1216. Epub 2010 Feb 11.
The aim of this study was to examine differences between adolescents and adults in persistence of the benefits of intensive therapy 10 years after completion of the Diabetes Control and Complications Trial (DCCT).
During the Epidemiology of Diabetes Interventions and Complications (EDIC) study, progression of retinopathy from DCCT closeout to EDIC year 10 was evaluated in 1,055 adults and 156 adolescents.
During 10 years of follow-up, HbA(1c) (A1C) was similar between original intensive (INT) and conventional (CON) groups and between former adolescents and adults. At EDIC year 10, adults in the former INT group continued to show slower progression of diabetic retinopathy than those in the CON group (adjusted hazard reduction 56%, P < 0.0001), whereas in adolescents this beneficial effect had disappeared (32%, P = 0.13). Seventy-nine percent of observed differences in the prolonged treatment effect between adults and adolescents at year 10 were explained by differences in mean A1C during DCCT between adolescents and adults (8.9 vs. 8.1%), particularly between INT adolescents and adults (8.1 vs. 7.2%).
Prior glycemic control during DCCT is vital for the persistence of the beneficial effects of INT therapy 10 years later. Lowering A1C to as close to normal as safely possible without severe hypoglycemia and starting as early as possible should be attempted for all subjects with type 1 diabetes. These results underscore the importance of maintaining A1C at target values for as long as possible because the benefits of former INT treatment wane over time if A1C levels rise.
本研究旨在探讨糖尿病控制与并发症试验（DCCT）结束后 10 年，强化治疗获益持续存在方面青少年与成人之间的差异。
在糖尿病干预与并发症流行病学（EDIC）研究期间，评估了 1055 名成年人和 156 名青少年从 DCCT 结束到 EDIC 第 10 年时视网膜病变的进展情况。
在 10 年的随访期间，原强化（INT）和常规（CON）组以及前青少年和成年人之间的糖化血红蛋白（A1C）相似。在 EDIC 第 10 年时，前 INT 组的成年人继续表现出糖尿病视网膜病变进展较慢，与 CON 组相比（调整后的危险降低 56%，P<0.0001），而青少年的这种有益效果已经消失（32%，P=0.13）。在第 10 年时，成年人与青少年之间延长治疗效果的差异中，有 79%可以用青少年与成年人在 DCCT 期间的平均 A1C 差异来解释（8.9 与 8.1%），尤其是 INT 青少年与成年人之间的差异（8.1 与 7.2%）。
DCCT 期间的先前血糖控制对于强化治疗 10 年后获益的持续存在至关重要。应尝试尽可能安全地将 A1C 降低到接近正常水平，而不出现严重低血糖，并尽早开始，对于所有 1 型糖尿病患者都应如此。这些结果强调了尽可能长时间地将 A1C 维持在目标值的重要性，因为如果 A1C 水平升高，前 INT 治疗的获益会随着时间的推移而逐渐减弱。
