We contacted Suzanne Strowig, MSN, RN, CDE, of the University of Texas in Dallas, in a phone interview regarding the recently completed Diabetes Control and Complications Trials (DCCT). Suzanne was the Trial Coordinator for the Texas area which included 22 people.
DIABETES HEALTH: What do you think of the study?
Suzanne: I thought the study was conducted incredibly well; there was more than 98% compliance to protocols and about a 99% follow up rate. The patients were terrific, but it was tough to maintain the tight goals the study required. It’s a real challenge to get people to achieve normal glucose control for up to 9 1/2 years. In general practice if someone is high for a few weeks, we can just say “well, we did our best,” but in the study we didn’t have that luxury. We had to meet the goals, so we had to fine tune our techniques.
DI: What kind of effect do you think the results of the DCCT will have on diabetes care in the future?
Suzanne: I think it will have a tremendous effect. We can now say with absolute certainty that tight control reduces complications; the standard of diabetes care must now change. The message that the DCCT results should impart is that each treatment must be tailored to the individual, and intensive therapy is not right for everyone. Intensive therapy is a lot more than just insulin: it is very much a team effort. Frequent visits to a physician and a dietitian, proper blood glucose monitoring, patient education, and support by nurses and other health care professionals in solving the problems that arise are essential parts of intensive therapy.
DI: Of the patients on the intensive therapy, how many used the pump and how many used multiple injections?
Suzanne: There was a 50-50 split between the standard and intensive treatments, and approximately 56% of the intesive group were on a pump for at least part of the study.
DI: Some of the patients I spoke to were transferred to the pump during pregnancies, was this standard protocol?
Suzanne: It was standard protocol to transfer anyone in the standard therapy group who became pregnant to one of the intensive therapy programs; sometimes it was the pump, and sometimes it was the multiple injections.
DI: Have many of the patients expressed an interest in changing the type of therapy they were using during the test? If so, from what therapy to what therapy?
Suzanne: I can only speak for the patients in my clinic, but all of the people using intensive therapy will continue to use intensive therapy. Three patients who were on the pump elected to go back to multiple injections, and three or four patients can’t afford to keep the pump, but most will stay with it. Most people can do very well on the pump.
DI: How many patients don’t have the financial means to start or maintain intensive therapy?
Suzanne: Again, I can only speak for my trial group, and I don’t know how much it will cost them, but I would guess that 1/3 of the patients don’t have insurance and may have financial difficulties.
DI: The people on standard therapy seemed to gain less weight than those on the intensive therapy, but was there any difference in the amount of weight gained by people on the pump and people using multiple injections?
Suzanne: There are no results on that, so it would be inappropriate to comment, but my guess would be that there is no difference between the types of intensive therapy. The reason there is a difference in weight gain between the standard and intensive groups is because of calorie wasting. People with high blood sugars use calories less efficiently, and excess calories are often lost in the urine. In people with more normal blood glucose levels the calories are used more efficiently and the body is able to store excess calories in the normal way: fat. The problem should be easily corrected by modifying caloric intake to meet caloric needs. I don’t recommend high blood sugar as a weight loss program.