1. Aftab Aziz
19/12/13

2. 1441 pt with T1DM
Secondary
Prevention
Primary Prevention
n=726
Conventional
therapy
n=378
•
•
•
•
•
Intensive therapy
n=348
n=715
Conventional
therapy
n=352
Intensive therapy
n=363
Randomised, multicentre trial
1441 pts recruited from 29 centres 1983-89
Av follow-up was 6.5 yrs (mean 3-9)
Inclusion age 13-39 yrs, Type 1 DM
Primary prevention arm
– 1-5 yrs DM, no retinopathy or nephropathy
• Secondary prevention arm
– 1-15yrs DM, M NPRetinopathy, Ur Microalb <200mg/24 hrs

3. Glycemic control
16.6
13.8
11.1
8.3
5.5
• HbA1c improvement in intensive vs. conventional treated
group (p0.001)
• Mean glucose level 8.6mmol/l vs. 12.8mmol/l (p<0.001)

4. Retinopathy
• Primary prevention group (Intensive vs. conventional)
– 23 vs 91 pts developed retinopathy in 6 years followup (Mean risk
reduction 76%)
• Secondary prevention group (Intensive vs. conventional)
– 77 vs 143 pts developed progressive retinopathy (Mean risk reduction
54%)
– 47% reduction of severe retinopathy, 56% reduction in laser
photocoagulation
• Transient worsening of retinopathy (22% vs. 13%) 18 months

5. Nephropathy
• Primary prevention group
– Mean risk reduction for microalbuminuria by 34% (p 0.04) intensive gp
• Secondary prevention group
– Mean risk reduction for microalbuminuria by 43% (p 0.001) intensive gp
• Risk reduction in albuminuria (54%) and microalbunimuria
(39%) in intensive treatment arms

6. Neuropathy
• Primary Prevention group
– 3% vs 10% developed neuropathy (69% reduction of neuropathy by 5
years, p0.006)
• Secondary Prevention group
– 7% vs 16% developed neuropathy (57% reduction of neuropathy by 5
years)

7. Secondary analysis
•
•
•
•
•
•
•
Severe hypoglycemic episodes 62 vs. 19/100 pt yrs
Hypoglycemia Coma / seizure episodes 16 vs. 5/100 pt yrs
Hospitalisation 54/40 pts vs. 36/27 pts
Major accidents 20 vs. 22 (2 fatalities, 1 vs. 1)
No difference in neuropsycholgical function
No death, MI or stroke
Wt gain ( overweight 12.7 vs. 9.3 /100 pt yrs)