Long-term research studies impact the treatment of type 1 diabetes worldwide

LONDON, ON – Findings from the Diabetes Control and Complications Trial (DCCT) and Epidemiology of Diabetes Interventions and Complications (EDIC) studies have changed the way type 1 diabetes is treated worldwide.

In 1983, when DCCT began, researchers from Lawson Health Research Institute (Lawson) and Western University’s Schulich School of Medicine and Dentistry were interested in learning whether participants who kept their blood glucose levels as close to normal as possible could prevent the development or progression of complications of diabetes, compared to those who used the conventional treatment at the time.

Participants were randomized into one of two groups; one that received intensive treatment (three or more insulin injections per day or an insulin pump with self-monitoring of blood glucose), or one that received the standard treatment (one or two injections of insulin per day with self-monitoring of urine or blood glucose). DCCT ended one year earlier than planned when it became evident that participants who kept blood glucose levels close to normal greatly decreased their chances of developing eye, kidney and nerve disease.

“The study showed such strong results that it was necessary to stop the trial, and immediately begin treating type 1 diabetes differently. Diabetic retinopathy and kidney damage were significantly reduced in the group receiving intensive treatment,” says Lawson Research Coordinator, Marsha Driscoll. “When the study ended in 1993, it was published in the New England Journal of Medicine.  The results quickly led to more intensive strategies to manage type 1 diabetes.” The study was one of the earliest multicentre clinical trials to be conducted worldwide and set the stage for future studies. 

Tom Holbrook was one of the original participants to join DCCT when it began. “I was randomized into the intensive treatment group. Through the trial I was given access to the latest technology at the time, including an insulin pump and finger-prick blood glucose testing. It was helpful because we didn’t feel like we had to manage our diabetes on our own, we all had the best doctors and the best treatments available,” Holbrook states.

When DCCT ended, participants were invited to continue in EDIC, an observational follow-up study. With over 24 study sites across Canada and the United States, and over 1,400 dedicated participants, scientists and physicians around the world are able to use the information from these studies to guide their own research and clinical practice. 

“Follow up of these patients has been ongoing for over 26 years and will continue beyond 2020, making this one of the longest follow up studies of diabetes patients ever. 90 per cent of the patients are still actively followed, which is remarkable for a study of this duration,” explains Driscoll.

Today, EDIC participants meet with researchers once a year for blood-work, cognitive testing, cardiac MRI, and various other tests which monitor their disease over the long-term. “Through the enormous amount of data collected, we are able to see the long-term impacts of diabetes intervention, and researchers around the world are using our information to study the avoidance and treatment of the complications of diabetes,” adds Driscoll.

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