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Meal Planning Approaches Used In The Diabetes Control And Complications Trial (dcct) Include

Diabetes Control And Complications Trial (dcct)

Diabetes Control And Complications Trial (dcct)

You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Diabetes Control and Complications Trial (DCCT) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. ClinicalTrials.gov Identifier: NCT00360815 National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information Background. Long-term microvascular and neurologic complications cause major morbidity and mortality in patients with insulin-dependent diabetes mellitus (IDDM). We examined whether intensive treatment with the goal of maintaining blood glucose concentrations close to the normal range could decrease the frequency and severity of these complications. Methods. A total of 1441 patients with IDDM -- 726 with no retinopathy at base line (the primary-prevention cohort) and 715 with mild retinopathy (the secondary-intervention cohort) were randomly assigned to intensive therapy administered either with an external insulin pump or by three or more daily insulin injections and guided by frequent blood glucose monitoring or to conventional therapy with one or two daily insulin injections. The patients were followed for a mean of 6.5 years, and the appearance and progression of retinopathy and other complications were assessed regularly. The major criteria for eligibility included insulin dependence, as evidenced by deficient C-peptide secretion; an age of 13 to 39 years; and the ab Continue reading >>

The Message Of The Dcct For Children And Adolescents

The Message Of The Dcct For Children And Adolescents

The Diabetes Control and Complications Trial (DCCT) tested the "glucose hypothesis" and established conclusively the association between higher glucose levels and long-term complications (retinopathy, nephropathy, and neuropathy). In contrast to the conventionally treated group, subjects who were intensively treated had individualized glucose targets, frequent adjustments based on ongoing capillary blood glucose monitoring, and a team approach that focused on the person with diabetes as the prime initiator of ambulatory self-care. The philosophy of care developed for and by the intensively treated patients was constantly adjusted toward reaching normal or near-normal glycemic goals, while keeping in mind the "prime directive" of avoiding or minimizing severe episodes of hypoglycemia. Office/ambulatory visits with a member of a multidisciplinary diabetes treatment team occurred monthly. Weekly telephone contact between visits was common if target goals were not satisfied. Flexible algorithms for food, insulin, and activity were created and evaluated using home glucose monitoring results and monthly glycohemoglobin test results. Teaching emphasized a proactive (preventive) approach to blood glucose fluctuations with constant re-adjustment (reactive approach) to counterbalance any high or low glucose readings (Table 1). The focal person on each multidisciplinary team was the diabetes nurse educator/clinician, with close collaboration with the dietitian, diabetologist, exercise physiologist, psychologist, social worker, and psychiatrist as appropriate. Target glucose goals were adjusted upwards if hypoglycemia could not be prevented. This was especially important in those who had recurring episodes of severe hypoglycemia. but produced dramatic reduction of retinopathy, nep Continue reading >>

Helping Your Patient With Diabetes Manage His Diet

Helping Your Patient With Diabetes Manage His Diet

Helping your patient with diabetes manage his diet Are you providing your patient with diabetes the latest thinking on meal planning? Are you sure he understands the concept of carbohydrate counting? Read on to help him understand these ideasand improve his quality of life. Having learned during morning rounds that this patient has diabetes, you walk into her room after lunch and notice she ate all the food on her lunch tray. You also notice that it was a "regular" tray. You walk into his room and note that he's consumed a fruit platter that his neighbors sent him. Mr. Jones has had Type 1 diabetes for 10 years. At 10 p.m., you find that Mrs. Rogers' blood glucose level is 181 mg/dl. You administer her bedtime medication. Some 30 minutes later, you realize that her bedtime snack is still in the refrigerator. Having just been diagnosed with diabetes, this patient is ready for discharge. As he gets ready to leave, he informs you that he's going to the supermarket to purchase only dietetic or sugar-free foods. Was Mrs. Smith in trouble? Did you think that Mr. Jones understood his diet management for diabetes? Did you wake Mrs. Rogers to have her eat her bedtime snack? Finally, did you reinforce Mr. Ogilvy's understanding about food selection? In helping your patient with diabetes, you have to take many factors into consideration. Among the most important ones are meal planning and understanding new nutrition guidelines. In this article, we'll provide some of the latest information in these crucial areas. In June 1993, the American Diabetes Association released the findings of the Diabetes Control and Complication Trial (DCCT). The study showed tight blood glucose control reduced the complications of diabetes, including retinopathy (reduced by 60%); neuropathy (reduced by Continue reading >>

Mnt Exam #2 Flashcards | Quizlet

Mnt Exam #2 Flashcards | Quizlet

low blood glucose concentrations in response to no food intake for 8 hours or longer impaired gastric motility; results in delayed or irregular contractions of the stomach, leading to various gastrointestinal symptoms such as feelings of fullness, bloating, nausea, vomiting, diarrhea, or constipation glucose intolerance, the onset or first recognition of which occurs during pregnancy a measurement of the relative area under the postprandial glucose curve of 50 g of digestible carbohydrates compared with 50 g of a standard food, either glucose or white bread the estimated GL of foods, meals and dietary patterns is calculated by multiplying the glycemic index by the amount of carbohydrate in each food and then totaling the values for all foods in a meal or dietary pattern a hormone produced by the alpha cells of the pancreas that causes an increase in blood glucose levels by stimulating the release of glucose from liver glycogen stores drugs administered orally that are used to control or lower blood glucose levels, including first- and second-generation sulfonylureas, nonsulfonylureas, secretagogues, biguanides, alpha glucosidase inhibitors, and thiazolidinediones Beta cells chronically exposed to hyperglycemia become progressively less efficient in responding to a glucose challenge a blood test that reflects the blood glucose concentration over the life span of red blood cells (~120 days), expressed as a percentage of total hemoglobin with glucose attached; also may be called glycated hemoglobin or glycohemoglobin the period after the initial diagnosis of type 1 diabetes when there may be some recover of beta cell function and temporary decrease in exogenous insulin requirement excessive glucose in the blood (generally 180 mg/dl or above) caused by too little insulin, Continue reading >>

The Diabetes Control And Complications Trial/epidemiology Of Diabetes Interventions And Complications Study At 30 Years: Summary And Future Directions

The Diabetes Control And Complications Trial/epidemiology Of Diabetes Interventions And Complications Study At 30 Years: Summary And Future Directions

The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study at 30 Years: Summary and Future Directions Rose A. Gubitosi-Klug and for the DCCT/EDIC Research Group* Department of Pediatrics, Rainbow Babies and Childrens Hospital, Cleveland, OH Corresponding author: Rose A. Gubitosi-Klug, [email protected] . Received 2013 Sep 10; Accepted 2013 Oct 3. Copyright 2014 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See for details. This article has been cited by other articles in PMC. The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study continues to address knowledge gaps in our understanding of type 1 diabetes and the effects of intensive therapy on its long-term complications. During the DCCT (19821993), a controlled clinical trial of 1,441 subjects with type 1 diabetes, and the EDIC (1994present), an observational study of the DCCT cohort, core data collection has included medical history questionnaires, surveillance health exams, and frequent laboratory and other evaluations for microvascular and macrovascular disease. Numerous collaborations have expanded the outcome data with more detailed investigations of cardiovascular disease, cognitive function, neuropathy, genetics, and potential biological pathways involved in the development of complications. The longitudinal follow-up of the DCCT/EDIC cohort provides the opportunity to continue monitoring the durability of intensive treatment as well as to address lingering questions in type 1 diabetes research. Future planned analyses will address the onset and progression of Continue reading >>

Carbohydrate Counting-1: South Asian Framework

Carbohydrate Counting-1: South Asian Framework

Carbohydrate counting-1: South Asian framework Lovely Gupta ( Department of Dietetics, Maharaja Agrasen Hospital, New Delhi, India. ) Deepak Khandelwal ( Department of Endocrinology, Maharaja Agrasen Hospital, New Delhi, India. ) Sanjay Kalra ( Department of Endocrinology, Bharti Hospital, Karnal, India. ) Carbohydrate counting or "carb counting" is a meal planning technique for persons with diabetes for managing blood glucose levels by tracking the grams of carbohydrate consumed at meals. It has shown to improve glycaemic control and glycaemic variability and decreases risk of hypoglycaemia in persons with diabetes especially on insulins. It needs basic education of the patient regarding meal plan, assessment of carbohydrate content of various foods and also exchange lists. It also gives flexibility of food choice, helps to identify patterns in blood glucose levels and adjustment of pre meals short acting insulins as related to food intake. In this short review we have summarised basic principles of carbohydrate counting, its application in clinical practice and also exchange lists primarily pertaining to South Asian population. Carbohydrate counting, Exchange list, Diabetes, Glucose monitoring, Insulin. Carbohydrate counting or "carb counting," is a meal planning technique for managing blood glucose levels by tracking the grams of carbohydrate consumed at meals and snacks. It focuses on carbohydrate as the primary nutrient affecting postprandial glycaemic response. Foods that contain higher carbohydrates have the greatest effect on post-prandial blood glucose levels as compared to foods that contain primarily protein or fat.1 This concept has been used since 1960s and was even used as meal planning approach in Diabetes Control and Complications Trial (DCCT) for inten Continue reading >>

30 Years Later, A Landmark Study Lives On

30 Years Later, A Landmark Study Lives On

30 Years Later, a Landmark Study Lives On The Diabetes Control and Complications Trial supported intensive therapy By Erika Gebel Berg, PhD, and Kelly Rawlings Tracy Waters was one of 1,441 study volunteers. Today, she is a registered nurse. Before we ask a person to take on the daily tasks of intensive insulin therapy to manage blood glucosethe finger pricks, the dosing, the advanced carbohydrate countingthere's an important question. Is all that effort worth it? The answer was decades in the making. In 1922, beef pancreas "extract" saved the life of 14-year-old Leonard Thompson. Even with insulin injections, people with diabetesif they lived long enoughoften developed serious complications, such as blindness, amputations, and kidney failure. But maybe that destiny could be altered. "Solving the riddle of what was responsible for these complications, and whether we could prevent or delay them, was the key question," recalls David M. Nathan, MD, professor of medicine at Harvard Medical School. The Diabetes Control and Complications Trial (DCCT) launched in 21 medical centers across the United States and Canada and later expanded to 28 centers. Intensive therapy, aimed at mimicking the way the body secretes insulin, began to emerge around 1980. It included multiple daily insulin injections or brick-size insulin pumps, blood glucose meters, and the A1C test (a measure of average blood glucose for the previous two to three months). These brave new approaches were far from standard practice. Conventional treatment had tried to make insulin injections more convenient, meaning fewer of themjust one or two shots a day. "You'd have fair blood glucose control throughout the day, but nowhere near normal control," Nathan says. Intensive insulin therapy was difficult, demanding mu Continue reading >>

Epidemiology Of Diabetes Interventions

Epidemiology Of Diabetes Interventions

Diabetes Control and Complications Trial / and Complications Study DCCT / EDIC The First 30 Years Created in recognition of the continued commitment and valuable contributions of the DCCT/EDIC participants by: Annette Barnie, Davida Kruger, Susan Hitt, Lucy Levandoski, Janie Lipps, Gayle Lorenzi, Suzanne Strowig, and Stephan Villavicencio on behalf of the DCCT/EDIC Study Group. Table of Contents Chairmen’s Corner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Message from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Evaluation Report: Special Statutory Funding Program for Type 1 Diabetes Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 How It All Began . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 The Diabetes Control and Complications Trial (DCCT) . . . . . . . . . . . . . . . . . . . 13 Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Randomization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Location of Clinical Centers and Participants . . . . . . . . . . . . . . . . . . . .20/21 After Randomization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 1993: The Year of Transition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Introducing the Epidemiology of Diabetes Interventions and Complications (EDIC) Study . . . . . . . . . . . . . . . . . . . . . . . . . . . Continue reading >>

Effect Of Intensive Diabetes Treatment On The Development And Progression Of Long-term Complications In Adolescents With Insulin-dependent Diabetes Mellitus: Diabetes Control And Complications Trial

Effect Of Intensive Diabetes Treatment On The Development And Progression Of Long-term Complications In Adolescents With Insulin-dependent Diabetes Mellitus: Diabetes Control And Complications Trial

Get rights and content The Diabetes Control and Complications Trial has demonstrated that intensive diabetes treatment delays the onset and slows the progression of diabetic complications in subjects with insulin-dependent diabetes mellitus from 13 to 39 years of age. We examined whether the effects of such treatment also occurred in the subset of young diabetic subjects (13 to 17 years of age at entry) in the Diabetes Control and Complications Trial. One hundred twenty-five adolescent subjects with insulin-dependent diabetes mellitus but with no retinopathy at baseline (primary prevention cohort) and 70 adolescent subjects with mild retinopathy (secondary intervention cohort) were randomly assigned to receive either (1) intensive therapy with an external insulin pump or at least three daily insulin injections, together with frequent daily blood-glucose monitoring, or (2) conventional therapy with one or two daily insulin injections and once-daily monitoring. Subjects were followed for a mean of 7.4 years (4 to 9 years). In the primary prevention cohort, intensive therapy decreased the risk of having retinopathy by 53% (95% confidence interval: 1% to 78%; p = 0.048) in comparison with conventional therapy. In the secondary intervention cohort, intensive therapy decreased the risk of retinopathy progression by 70% (95% confidence interval: 25% to 88%; p = 0.010) and the occurrence of microalbuminuria by 55% (95% confidence interval: 3% to 79%; p = 0.042). Motor and sensory nerve conduction velocities were faster in intensively treated subjects. The major adverse event with intensive therapy was a nearly threefold increase of severe hypoglycemia. We conclude that intensive therapy effectively delays the onset and slows the progression of diabetic retinopathy and nephropa Continue reading >>

The Importance Of Carbohydrate Counting In The Treatment Of Children Withdiabetes.

The Importance Of Carbohydrate Counting In The Treatment Of Children Withdiabetes.

1. Pediatr Diabetes. 2007 Oct;8 Suppl 6:57-62. The importance of carbohydrate counting in the treatment of children withdiabetes. (1)Department of Pediatrics, Osaka City University Graduate School of Medicine, Osaka, Japan. [email protected] Carbohydrate (Carb) counting is a meal planning approach for patients withdiabetes mellitus that focuses on carbohydrate as the primary nutrient affecting postprandial glycemic response. The concept of carb counting is not new. In theearly 1990's the Diabetes Control and Complications Trial (DCCT) used carbcounting as one of its education tools. More recently, short acting insulinanalogues and insulin pumps have made the role of carb counting important andpopular. Carb counting can be used in conjunction with a meal plan to setcarbohydrate targets at each meal and snack. It is also used, perhaps morecommonly, to estimate carbohydrate intake and adjust insulin around mixed mealsand snacks using insulin to carbohydrate ratio. This effectively addresses thevariable eating habits of most children and adolescents. The method may beadapted for patients who use a conventional insulin regimen and may meet theneeds of patients who use multiple daily injections (MDI) or an insulin pump.Carb counting can make food planning flexible and enjoyable for patients, and themeal planning approach is very important for the physical growth andpsychological development of children with diabetes. This paper describes theimportance of carb counting for childhood diabetes as well as some of the specialaspects associated with it. Continue reading >>

Nelson Textbook Of Pediatrics E-book

Nelson Textbook Of Pediatrics E-book

0 Reviews For nearly three quarters of a century, Nelson Textbook of Pediatrics has been the world's most trusted resource for best approaches to pediatric care. Now in full color for easier referencing, this New Edition continues the tradition, incorporating a wealth of exciting updates and changesensuring you have access to today's authoritative knowledge to best diagnose and treat every pediatric patient you see. Whether you're treating patients in the office or in the hospital, or preparing for the boards, Nelson Textbook of Pediatrics, 18th Edition is your comprehensive guide to providing the best possible care. Get an enhanced focus on general pediatrics with editorial contributions from new editor Dr. Bonita F. Stanton. Treat your inpatient and ambulatory patients more effectively with the absolute latest on new topics such as quality improvement and patient care safety *school violence and bullying * preventive measures * vitamin deficiencies * adolescent rape * effect of war on children * and more. Improve your therapeutic skills with the newest knowledge on the principles of antibiotic therapy * antiviral therapy * antiparasitic therapy * antimycobacterial therapy * and others. Understand the principles of therapy and which drugs and dosages to prescribe for every disease. Locate key content more easily and identify clinical conditions quicker thanks to a new full-color design and full-color photographs.

Multiple Daily Insulin (mdi)

Multiple Daily Insulin (mdi)

Multiple daily insulin (MDI), also called a basal/bolus routine,is a proactive approach. Most people with type 1 diabetes should use this approach. It requires careful attention to meals and exercise planning, but allows a more flexible schedule. Its like flying a jumbo jet compared to a one-engine plane. It may be more complex but there is also more potential. The benefits of MDI are that people can change their activities more, and dont have to eat meals at the same time every day because they are taking insulin before every meal.MDI aims to provide a steady stream of insulin throughout the day, similar to the way the pancreas does. This is done with 4 or 5 daily injections, or an insulin infusion pump and extra insulin at mealtime. A bolus dose of rapid-acting or short-acting insulin is usually taken with all meals (breakfast, lunch, and dinner) and sometimes with an afternoon or evening snack. Long-acting (basal) insulin is taken once a day, usually at supper or at bedtime. The dose of the rapid-acting insulin is based on 3 things: the amount of carbohydrate about to be eaten the activity planned over the next 2 to 3 hours When the blood sugar goes higher than the target before a given meal, there is a chance to give some extra short-acting or rapid-acting insulin right then, to bring the blood sugar back into the target range. Likewise, if the blood sugar level is under 4 mmol/L (70 mg/dL) just before a meal, or if a lot of exercise is planned in the next few hours, the insulin dose can be reduced immediately. The use of MDI allows for more intensive management of diabetes. The use of MDI to intensify diabetes management was central to the ground-breaking Diabetes Control and Complications Trial (DCCT). This was a U.S. government-funded study that looked at the ef Continue reading >>

Intersection Of Adolescent Development And Intensive Intervention: Age-related Psychosocial Correlates Of Treatment Regimens In The Diabetes Control And Complication Trial | Journal Of Pediatric Psychology | Oxford Academic

Intersection Of Adolescent Development And Intensive Intervention: Age-related Psychosocial Correlates Of Treatment Regimens In The Diabetes Control And Complication Trial | Journal Of Pediatric Psychology | Oxford Academic

Objective: To provide evidence relevant to developmentally sensitive intervention and prevention of adolescents' psychosocial distress associated with treatment of type 1 diabetes. Methods: We used self-reports on the Diabetes Quality of Life and SCL-90-R inventories administered at baseline, 1, and 3 years following adolescents' (n = 224) entry into the Diabetes Control and Complications Trial. Results: Initiation of intensive treatment in early adolescence was associated with increasing school dissatisfaction; initiation in later adolescence resulted in marginal elevations in psychological distress. Conclusions: Age at entry moderates impact of intensive treatment on reported psychosocial distress. Intervention and prevention efforts sensitive to the interaction of developmental tasks with health treatment goals may optimize the well-being of adolescents with type 1 diabetes. adolescence , type 1 diabetes , intervention , psychosocial effects Adolescence has captured the attention of health care professionals as a period presenting problems, as well as great promise, for the successful treatment of patients with chronic illnesses. Although the rapid biological, social, and cognitive changes of adolescence can pose difficulties, the window between childhood and adulthood is thought to be an important time for establishing lifelong health habits, rendering adolescence a key period in which to substantially influence future health trajectories ( Millstein, 1989 ). The challenges of managing adolescent health pertain especially to the work of health professionals treating adolescents with type 1 diabetes. Managing this lifelong disease and minimizing its undesirable physiological sequelae require regular blood glucose monitoring, administering insulin at the appropriate Continue reading >>

The Diabetes Control And Complications Trial/epidemiology Of Diabetes Interventions And Complications Study At 30 Years: Overview

The Diabetes Control And Complications Trial/epidemiology Of Diabetes Interventions And Complications Study At 30 Years: Overview

The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study at 30 Years: Overview David M. Nathan and for the DCCT/EDIC Research Group* Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Data Coordinating Center, George Washington University, Biostatistics Center, Bethesda, MD Corresponding author: David M. Nathan, [email protected] Received 2013 Sep 7; Accepted 2013 Sep 25. Copyright 2014 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See for details. This article has been cited by other articles in PMC. The Diabetes Control and Complications Trial (DCCT) was designed to test the glucose hypothesis and determine whether the complications of type 1 diabetes (T1DM) could be prevented or delayed. The Epidemiology of Diabetes Interventions and Complications (EDIC) observational follow-up determined the durability of the DCCT effects on the more-advanced stages of diabetes complications including cardiovascular disease (CVD). The DCCT (19821993) was a controlled clinical trial in 1,441 subjects with T1DM comparing intensive therapy (INT), aimed at achieving levels of glycemia as close to the nondiabetic range as safely possible, with conventional therapy (CON), which aimed to maintain safe asymptomatic glucose control. INT utilized three or more daily insulin injections or insulin pump therapy guided by self-monitored glucose. EDIC (1994present) is an observational study of the DCCT cohort. The DCCT followed >99% of the cohort for a mean of 6.5 years and demonstrated a 3576% reduction in the early stages of microvascular disease with INT, with a Continue reading >>

Diabetes Tutorial | Carbohydrate Counting

Diabetes Tutorial | Carbohydrate Counting

Carbohydrate counting is another method used for meal planning for diabetics. It has been used in the US since insulin was discovered, and is one of the meal approaches that was successfully used in the Diabetes Controls and Complications Trial (DCCT). Benefits of carbohydrate counting include greater flexibility in food choices and improved glucose control*. Diabetics need to be educated about the types of foods containing carbohydrates and the amount of carbohydrate. Education on portion sizes-equal to one serving of carbohydrate and how to divide those foods into individual meals and snacks is also necessary. The patient adjusts insulin dosage (via syringe or pump) according to food intake. Typically, the patient injects long acting insulin to cover basal levels, and injects rapid acting insulin depending on when food is consumed and the carbohydrate content. The amount of insulin injected prior to food intake depends on the patient's weight and the carbohydrate content of the meal. The patient has an insulin units to carbohydrate grams ratio depending on their weight. They figure the carbohydrate content in the food they plan to eat and divide by the ratio value. For example, if a person's ratio is 1:10 and they were to consume 30 grams of carbohydrate, they would inject 30/10 = 3 units of insulin. For more information on carbohydrate counting, see the following websites: Continue reading >>

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