The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Effects of Intensive Diabetes Therapy on Neuropsychological Function in Adults in the Diabetes Control and Complications Trial

The Diabetes Control and Complications Trial Research Group*
[+] Article, Author, and Disclosure Information

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;124(4):379-388. doi:10.7326/0003-4819-124-4-199602150-00001
Text Size: A A A

Objective: To examine the effect of intensive therapy on neuropsychological performance in patients who participated in the Diabetes Control and Complications Trial (DCCT).

Design: Multicenter, randomized, controlled clinical trial.

Setting: 29 DCCT clinical centers.

Patients: 1441 patients with insulin-dependent diabetes mellitus (IDDM) between 13 and 39 years of age who had had IDDM for 1 to 15 years and had no or minimal retinopathy or nephropathy at baseline. Volunteers were excluded if they had a history of substance abuse, psychological disturbance, or recurrent hypoglycemia with coma or seizure.

Intervention: Intensive therapy with 3 or more daily insulin injections or continuous subcutaneous insulin infusion, guided by 4 or more glucose tests per day, compared with conventional therapy with 1 or 2 daily insulin injections.

Outcome Measures: Neuropsychological assessments were done at baseline; years 2, 5, and 7; and the end of the study. Eight cognitive domain scores were developed from the test results and were used to identify patients whose neuropsychological performance had clinically worsened.

Results: Intensive therapy did not affect neuropsychological performance. In addition, patients who had repeated episodes of hypoglycemia did not perform differently than patients who did not have repeated episodes.

Conclusion: Intensive therapy and the attendant risk for hypoglycemia were not associated with neuropsychological impairment in the DCCT.

*A complete listing of members of the DCCT Research Group is available in Archives of Ophthalmology, 1995; 113:49-51.


Grahic Jump Location
Figure 1.
Association between baseline-centered Z scores for motor speed and glycosylated hemoglobin levels.

Each data point represents approximately 100 patients and is indicated by the year of follow-up visit (asterisk, year 2; diamond, year 5; circle, year 7). A spline function was used to fit a smooth line through the data points of each follow-up year in order to indicate the general trend of association in the year of follow-up visit. Data for year 9 contained only three points and were not plotted.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Distribution of the baseline-centered Z scores for problem solving and motor speed at the year 5 visit.

The diamonds represent patients who had more than one coma or seizure events per year up to the fifth year of study; the small dots represent the remaining patients. Twenty-one study patients had values outside of the range of the coordinates; one was patient A, who had had more than one coma or seizure event per year by year 5.

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.