Studies for DM

Question 1

Diabetes Control and Complications Trial (DCCT)

Answer 1

intensive therapy of T1Dm without cardiovascular disease effectively delays onset and progression of microvascular complications

Question 2

DCC/EDIC

Answer 2

“metabolic memory” early intensive therapy leads to sustained beneficial outcomes; intensive diabetes therapy has long term beneficial effects on risk of CV in pt with T1DM

Question 3

United Kingdom Prospective Diabetes Study (UKPDS-33)

Answer 3

intensive therapy with sulfonylureas or insulin decreases risk of MICROVASCULAR complications BUT NOT MACROVASCULAR. There was no difference in response to different glucose lowering therapies used for intensive treatment

Question 4

UKPDS-34

Answer 4

intensive therapy with metformin appears to decrease risk of diabetes related endpoints in overweight T2DM pt and is associated with less weight gain and fewer hypoglycemic events than sulfonylureas/insulin. As a result, it may be considered a first line agent in overweight pt ***this trial is what gave metformin its backing

Question 5

UKPDS-80

Answer 5

“legacy effect”- beneficial effects of intensive therapy early in diagnosis of DM2 are sustained up to 10 yrs after randomization to treatment arms was discontinued

Question 6

ACCORD, ADVANCE, VADT

Answer 6

More stringent A1c goals should be applied to:
a. Young, new diagnosis, no history of severe/frequent hypoglycemia, without serious comorbid conditions (heart disease, stroke)

Less stringent A1c goals
a. Older pt, longer duration of diabetes (>8 yrs), history of falls or severe hypoglycemic episodes, HgbA1c >8.5% after med trial for 1 yr, severe microvascular complications