Evidence for Glycated Hemoglobin Targets from the Diabetes Control and Complications Trial

Abstract

Purpose: To discuss targets for glycated hemoglobin in the context of findings in the Diabetes Control and Complications Trial (DCCT) and the followup Epidemiology of Diabetes Interventions and Complications Study. Findings: The DCCT demonstrated that intensive diabetes therapy is effective in reducing the glycated hemoglobin level in comparison with a program of conventional therapy. For the duration of the DCCT--a mean of 6.5 years and up to 9 years--subjects in the conventional-therapy group remained at or near the glycated hemoglobin level of 9.0%, which was the starting point for all study subjects. In contrast, in the intensive-therapy group, glycated hemoglobin was rapidly reduced to a 7.0% level and maintained between 7.0 and 7.5% to the end of the study period. For the intensive-therapy group, the calculated gain of complications-free living was 15.3 years, and the gain in life span was 5.1 years. A 1.54-fold risk of weight gain was observed in the intensive-therapy group; at the end of the study...