The DCCT and UKPDS were pivotal studies in type 1 and type 2 diabetes, respectively, examining the role of tight glycemic control. In the process of striving for intensified glucose
control, both studies identified incidence and prevalence rates for factors for their occurrence. However, in light of the many management that have occurred since the time of these studies,
hypoglycemia and risk advances in diabetes the data gleaned from
these reports by those opposing individual anticipated rates of hypoglycemia today – even glycemic control.
assessment do not provide evidence of for those potential drivers who strive for tight
Several initial observations help to put the data on hypoglycemia in these studies into the proper context. Rather than forming the final word on the risk of hypoglycemia in individuals with type 1 diabetes, the initial results of the DCCT, identifying a three-fold increase of severe hypoglycemia in the intensively treated group, were themselves used to identify risk factors that, once taken into account, resulted in a subsequent reduction of risk of severe
hypoglycemia in the final results of the DCCT. drivers who use insulin would have type 2 diabetes in the United States have this form of
3 In addition, the vast majority of potential diabetes, as 90 percent of all people with the disease. Major episodes of hypoglycemia
are far less common in this patient population. with insulin in the UKPDS, fewer than 5% hypoglycemic episode in a single year.
Even in those of individuals
individuals intensively treated experienced a single major
Moreover, the science of diabetes management has advanced significantly since the time of these studies, with major advances in the types of insulin available, the methods of insulin delivery, the means of self-monitoring blood glucose levels, and training available to improve self-assessment of hypoglycemia.
The DCCT and UKPDS were initiated with insulin regimens based upon the types of insulin available at the time, including animal source (beef, pork) insulins and extremely long acting Ultralente insulin, which has a notorious history of unpredictability and hypoglycemia. Newer more predictable insulin preparations – which have been shown to significantly reduce the risk of hypoglycemia – have replaced the preparations that were used at the time of these studies. Very rapid acting insulin (Insulin Lispro and Insulin Aspart) begins to work within 10 minutes of injection, as opposed to the traditional short acting regular insulin which requires injection 30 to 60 minutes prior to eating. Thus, under the prior insulin regimen, a driver would have had to stop, take insulin, continue driving while the insulin took effect, and then stop to eat. Today, a driver stops, takes insulin, eats immediately, and the insulin action is available while needed to store the ingested calories then is gone when the food has been absorbed. Insulins available at the time of these studies, on the other hand, continued to work for 4 to 6 hours after injection – long after food absorption had been completed. This
3 Diabetes Control and Complications Trial Research Group: Epidemiology of Severe Hypoglycemia in the Diabetes Control and Complications Trial. Am J Med 90:450-459 (1991).