1. Diabetes Journal Club January 19, 2012 Margaux Añel-Tiangco, MD

2. Background
Impaired GFR  ESRD and increases risk of CV disease and death
Pts with DM Type 1 are at risk for kidney disease but there are no interventions proven to prevent impaired GFR in this pop’n

3. Methods
DCCT (Diabetes Control and Complications Trial) = intervention trial
EDIC (Epidemiology of Diabetes Interventions and Complications) = observational study
Inclusion criteria:
DM Type 1, 1-15 yrs duration
Normal serum kidney funciton

4. Methods DCCT – multicenter trial
Intensive therapy group – goal A1c <6.05%
Conventional therapy group – goal of preventing sxs of hyper- and hypoglycemia
Mean f/u of 6.5 years
After study f/u, Intensive tx group encouraged to continue and Conventional tx group given instruction on intensive tx
Everyone saw their PCPs for f/u
EDIC – observational extension of DCCT

8. P<0.01

9. P<0.01
P<0.05

11. During EDIC
eGFR was higher and declined less rapidly among those assigned to intensive tx group in DCCT

15. Take home points
Intensive therapy for ~6.5 years early in the course of DM Type 1 with goal A1c ~7% decreases the long-term risk of impaired GFR
Effect not evident till >10 yrs after randomization
“Metabolic memory”
29 persons with DM Type 1 treated intensively for 6.5 years prevents 1 case of impaired GFT over a total follow-up of 20 years
Findings not applicable to those with DM Type 2 and DM Type 1 of longer duration

16. Questions?