Modern-day clinical course of type 1 diabetes mellitus after 30 years' duration: the diabetes control and complications trial/epidemiology of diabetes interventions and complications and Pittsburgh epidemiology of diabetes complications experience (1983-2005)

David M Nathan; Bernard Zinman; Patricia A Cleary; Jye-Yu C Backlund; Saul Genuth; Rachel Miller; Trevor J Orchard; Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Research Group

doi:10.1001/archinternmed.2009.193

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Modern-day clinical course of type 1 diabetes mellitus after 30 years' duration: the diabetes control and complications trial/epidemiology of diabetes interventions and complications and Pittsburgh epidemiology of diabetes complications experience (1983-2005)

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Modern-day clinical course of type 1 diabetes mellitus after 30 years' duration: the diabetes control and complications trial/epidemiology of diabetes interventions and complications and Pittsburgh epidemiology of diabetes complications experience (1983-2005)

David M Nathan, Bernard Zinman, Patricia A Cleary, Jye-Yu C Backlund, Saul Genuth, Rachel Miller, Trevor J Orchard and Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Research Group

Archives of internal medicine (1960), Vol.169(14), pp.1307-1316

07/27/2009

DOI: 10.1001/archinternmed.2009.193

PMCID: PMC2866072

PMID: 19636033

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Abstract

Clinical treatment goals of type 1 diabetes mellitus (T1DM) have changed since the Diabetes Control and Complications Trial (DCCT) demonstrated reduced long-term complications with intensive diabetes therapy. There have been few longitudinal studies to describe the clinical course of T1DM in the age of intensive therapy. Our objective was to describe the current-day clinical course of T1DM. An analysis of the cumulative incidence of long-term complications was performed. The DCCT (1983-1993) assigned patients to conventional or intensive therapy. Since 1993, the DCCT has been observational, and intensive therapy was recommended for all patients. The Pittsburgh Epidemiology of Diabetes Complications (EDC) study is an observational study of patients with T1DM from Allegheny County, Pennsylvania. The study population comprised the DCCT T1DM cohort (N = 1441) and a subset of the EDC cohort (n = 161) selected to match DCCT entry criteria. In the DCCT, intensive therapy aimed for a near-normal glycemic level with 3 or more daily insulin injections or an insulin pump. Conventional therapy, with 1 to 2 daily insulin injections, was not designed to achieve specific glycemic targets. Main outcome measures included the incidences of proliferative retinopathy, nephropathy (albumin excretion rate >300 mg/24 h, creatinine level >or=2 mg/dL [to convert to micromoles per liter, multiply by 88.4], or renal replacement), and cardiovascular disease. After 30 years of diabetes, the cumulative incidences of proliferative retinopathy, nephropathy, and cardiovascular disease were 50%, 25%, and 14%, respectively, in the DCCT conventional treatment group, and 47%, 17%, and 14%, respectively, in the EDC cohort. The DCCT intensive therapy group had substantially lower cumulative incidences (21%, 9%, and 9%) and fewer than 1% became blind, required kidney replacement, or had an amputation because of diabetes during that time. The frequencies of serious complications in patients with T1DM, especially when treated intensively, are lower than that reported historically.

Diabetes Mellitus, Type 1 - epidemiology

United States - epidemiology

Humans

Middle Aged

Blood Glucose

Insulin - administration & dosage

Diabetes Mellitus, Type 1 - complications

Diabetes Mellitus, Type 1 - therapy

Randomized Controlled Trials as Topic

Young Adult

Canada - epidemiology

Adolescent

Diabetes Complications - epidemiology

Adult

Hypoglycemia - chemically induced

Weight Gain

Insulin - adverse effects

Longitudinal Studies

Diabetic Ketoacidosis - chemically induced

Details

Title: Subtitle: Modern-day clinical course of type 1 diabetes mellitus after 30 years' duration: the diabetes control and complications trial/epidemiology of diabetes interventions and complications and Pittsburgh epidemiology of diabetes complications experience (1983-2005)
Creators: David M Nathan
Bernard Zinman
Patricia A Cleary
Jye-Yu C Backlund
Saul Genuth
Rachel Miller
Trevor J Orchard
Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Research Group
Contributors: H Culver Boldt (Contributor) - University of Iowa, Ophthalmology and Visual Sciences
Resource Type: Journal article
Publication Details: Archives of internal medicine (1960), Vol.169(14), pp.1307-1316
DOI: 10.1001/archinternmed.2009.193
PMID: 19636033
PMCID: PMC2866072
NLM abbreviation: Arch Intern Med
ISSN: 0003-9926
eISSN: 1538-3679
Publisher: American Medical Association; United States
Grant note: DK 034818 / NIDDK NIH HHS R37 DK034818 / NIDDK NIH HHS N01 DK062204-A / NIDDK NIH HHS R01 DK034818 / NIDDK NIH HHS N01 DK062204-007 / NIDDK NIH HHS
Language: English
Date published: 07/27/2009
Academic Unit: Ophthalmology and Visual Sciences
Record Identifier: 9983980012802771

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