This proposal seeks to answer the question: Will maintenance of normal or virtually normal blood glucose prevent, decrease, or reverse the microvascular (and possibly macrovascular) complications of insulin dependent diabetics. Suitable patients will be randomized into a conventionally treated control group and an experimental group treated with 4 insulin injections per day (or by continuous subcutaneous infusion). During a feasibility trial period of 1-2 years and a definitive period of 7 years, diabetics will be monitored by fundus photographs, fluorescein angiograms, renal function tests, nerve conduction tests, cardiophysiological tests, and muscle capillary basement membrane thickness. Home blood glucose monitoring will be used to facilitate and verify the """"""""tight"""""""" regulation of the experimental group. Statistical analysis of the data from all participating centers should give a broadly applicable answer to this critical question in diabetes management.
| Genuth, Saul; Sun, Wanjie; Cleary, Patricia et al. (2005) Glycation and carboxymethyllysine levels in skin collagen predict the risk of future 10-year progression of diabetic retinopathy and nephropathy in the diabetes control and complications trial and epidemiology of diabetes interventions and complications p Diabetes 54:3103-11 |
| Monnier, V M; Bautista, O; Kenny, D et al. (1999) Skin collagen glycation, glycoxidation, and crosslinking are lower in subjects with long-term intensive versus conventional therapy of type 1 diabetes: relevance of glycated collagen products versus HbA1c as markers of diabetic complications. DCCT Skin Co Diabetes 48:870-80 |
