Implications of the diabetes control and complications trial for renal outcomes and medical nutrition therapy.

The Diabetes Control and Complications Trial (DCCT) results have important implications related to the prevention and management of diabetic nephropathy. This paper provides an overview of the study design, methods and overall results with particular emphasis on renal outcomes and the role of medical nutrition therapy. The DCCT demonstrated that intensive diabetes therapy aimed at near normoglycemia resulted in a 39% reduction in the occurrence of microalbuminuria and a 54% reduction in the occurrence of albuminaria. Further analysis of DCCT data show that the impact of intensive therapy on renal outcomes may vary based on the stage of diabetic nephropathy, gender and prior exposure to hyperglycemia. This review highlights the clinical implications of the DCCT results for dietitians, nurses and physicians working with patients with diabetic nephropathy and describes post-DCCT advances in clinical practice and research.