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Trial results provide powerful message  Results of the Epidemiology of Diabetes Intervention and Complications (EDIC) study, released June 12 at the American Diabetes Association Annual Scientific session in San Diego, showed that intensive treatment of diabetes reduces future adverse cardiovascular complications.   MUSC nurse practitioner Denise Wood takes the blood pressure of Kathi Dixon of Anderson, a participant in a clinical trial to determine if intensive control of blood sugar levels reduces the cardiovascular complications of diabetes.  The multicenter study, involving 1394 participants, including 56 from South Carolina, Georgia and Florida followed at MUSC, is an extension of the groundbreaking Diabetes Control and Complications Trial (DCCT) which was closed in 1993 because overwhelming evidence showed that patients with type I diabetes benefit from intensive control of their blood sugar levels.    Dr. John Colwell  The results of DCCT, conducted from 1983 to 1993 by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), showed that keeping blood glucose levels as close to normal as possible slows the onset and progression of eye, kidney and nerve diseases caused by diabetes, said John Colwell, M.D., Ph.D., MUSC professor. Colwell is the former president of the American Diabetes Association and author of the medical text entitled Diabetes, who served as principal investigator for the MUSC site for both the EDIC and DCCT.   Kathi Dixon, a participant in the DCCT/EDIC clinical trials, maintains intensive control of her blood glucose levels with an insulin pump.  A total of 1,441 participants were enrolled in DCCT, and each patient was randomized into either an intensive blood sugar control group or a standard treatment group.  When the trial results indicated significant decreases in most of the complications from diabetes, it was recommended that all patients should achieve optimal control of their blood sugar levels by either using an insulin pump or very frequent needle stick checks and insulin adjustments.   Because the study participants in the initial DCCT trial were young, with a mean age of 27, and the fact that cardiovascular complications usually take a long time to manifest themselves, conclusions concerning the effects of intensive control of blood sugar levels on cardiovascular complications could not be drawn from DCCT.    The follow-up study (EDIC) was started in 1993 to monitor these patients as they aged. At that point, all study participants were put on the intensive control because of the DCCT findings. Some patients  spent a significant amount of time (six to seven years) with their blood glucose levels intensely controlled, during the earlier DCCT phase of the studies. The others were on standard treatment during that time period where their blood sugar levels were not as tightly controlled.    The study results presented June 12 showed for the first time that the reduction of cardiovascular complications of diabetes is an additional benefit of intensive control of blood sugar levels.   The intensive treatment during the DCCT phase resulted in a 42 percent reduction in the risk of developing cardiovascular complications. These complications include heart attacks, strokes, angina and the need for procedures to improve the blood supply to the heart, such as coronary artery bypass surgery and the insertion of stents in blocked coronary arteries.     The investigators broke down the cardiovascular complications and only looked at what they considered the less subjective end points, which were heart attack and stroke and found that there was a 58 percent risk reduction in these complications in patients who were in the intensive glucose control group during the DCCT phase of the trial.   “These are very significant results, and combined with the DCCT results we have a very powerful message for people with diabetes,” said Colwell. “The bottom line is that maintaining blood sugar levels as near normal as possible as soon as diabetes is diagnosed is a critical factor in avoiding the serious and sometimes deadly complications associated with diabetes.” REACH 2010 reduces number of amputations in blacks by Kathryne Young Public Relations REACH 2010, a local community-based coalition, reduced the number of amputations related to diabetes in blacks in Charleston and Georgetown counties by more than 50 percent in three years.  In 1999, the number of amputations in black males in these communities was 79.1 per 1000.  By 2002, the number of amputations fell to 31.7.    Gayenell Magwood, College of Nursing faculty member and project director for the local  REACH 2010, left, and Dr. Carolyn Jenkins, College of Nursing associate professor and principal investigator for the project, second from  right, meet with community health advocates who help get the message about diabetes care into the community. The community health advocates are Anna Johnson, with back to camera, Virginia Thomas, at Jenkins' left, and Sheila Powell, at Jenkins' right.  Carolyn Jenkins, Dr.P.H., R.N., a professor at MUSC College of Nursing (and principal investigator for the local REACH coalition), presented these findings at the American Diabetes Association Annual Scientific Session June 12 in San Diego.   “We knew that if we trained community leaders interested in diabetes and health professionals, it would make a difference, but we never knew it would make this much of a difference,” said Jenkins.   REACH 2010—Racial and Ethnic Approaches to Community Health:  Charleston and Georgetown Diabetes Coalition—is a group of community organizations and leaders that works towards reducing disparities for blacks with diabetes. The local coalition focuses on increasing community awareness, improving the quality of health care, and creating educational opportunities for blacks with diabetes. The local program is one of 40 REACH programs nationwide, each specializing in a particular health disparity.   The coalition spent more than a year planning solutions to reduce health disparities related to diabetes for more than 12, 000 blacks with diabetes in Charleston and Georgetown counties. They then formed a community action plan, linking REACH 2010 objectives to ongoing activities in the community through churches, local community groups, public libraries and health systems. As part of the project, five lay leaders work with health professionals within the community to get the message out about diabetes.    “This, as we predicted, improves diabetes management which should reduce health disparities,” said Jenkins.   Approximately 2.7 million blacks over the age of 20 have diabetes. Each year, 82,000 people lose a foot or leg as a consequence of diabetes, and more than 50 percent of amputations can be prevented with the proper care and precautions.   Faculty from MUSC College of Nursing and the Diabetes Initiative of South Carolina trained more than 130 nurses in Charleston County on how to perform proper foot exams, and the importance of proper foot wear for people with diabetes.  Many of the local nurses now volunteer their time to educate those struggling with diabetes on proper foot care techniques.      The REACH coalition is based in the MUSC College of Nursing and is under the direction of the Diabetes Initiative of South Carolina. The coalition, funded by the Centers for Disease Control and Prevention, works with the South Carolina Diabetes and Control program based at DHEC, Carolina Medical Review, the state quality improvement organization, and local community health centers.   The Office of Research and Statistics at the State Budget and Control Board collects data to evaluate changes in amputations.     Friday, June 17, 2005 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.