Long-term Complications

Hyperglycemia appears to be a key factor in the long-term complications associated with diabetes (Table 2). The Diabetes Control and Complications Trial (DCCT), Epidemiology of Diabetes Interventions and Complications (EDIC) study, and the U.K. Prospective Diabetes Study (UKPDS) demonstrated the need to aim for near normal glucose levels or normoglycemia in order to delay or minimize chronic complications (Table 3).

Table 2. Long-term Complications Associated with Diabetes.
MicrovascularMacrovascular
Periodontal diseaseCardiovascular disease
NeuropathyAngina
RetinopathyMyocardial infarction
NephropathyDyslipidemias
Hypertension
Cerebral vascular
Peripheral vascular disease
Table 3. Landmark Diabetes Studies.
Diabetes Control and Complications Trial (DCCT), 1993
  • Conducted between 1983-1993
  • Randomly selected 1441 patients (ages 13-40) with type 1 diabetes
  • Excluded participants with cardiovascular disease, hypertension, hypercholesterolemia
  • Goal: Compare the effects of an intensive diabetes treatment regimen with those of conventional therapy
  • Results: Consistent intensive therapy toward normoglycemia in individuals with type 1 diabetes has led to a significant reduction in the development and progression of microvascular complications associated with type 1 diabetes. More importantly, the study found that the long-term complications could be preventable for individuals with diabetes.
Epidemiology of Diabetes Interventions and Complications (EDIC), 2000
  • Follow-up study of the DCCT
  • 1394 of the participants from the DCCT
  • Goal: Continue with the DCCT and determine the outcomes over a longer period of time
  • Results: Continue to support the outcomes of the DCCT
United Kingdom Prospective Diabetes Study (UKPDS), 1998
  • Goal: Mimic the DCCT using individuals with type 2 diabetes
Diabetes Prevention Program (DPP), 2000
  • 14,000 participants
  • Goal: Screened high-risk individuals for the presence of IGT and FPG