Prolonged effect of intensive therapy on the risk of retinopathy complications in patients with type 1 diabetes mellitus: 10 years after the Diabetes Control and Complications Trial

Neil H White; Wanjie Sun; Patricia A Cleary; Ronald P Danis; Matthew D Davis; Dean P Hainsworth; Larry D Hubbard; John M Lachin; David M Nathan; Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group

doi:10.1001/archopht.126.12.1707

Back

Prolonged effect of intensive therapy on the risk of retinopathy complications in patients with type 1 diabetes mellitus: 10 years after the Diabetes Control and Complications Trial

Journal article

Open access

Peer reviewed

Prolonged effect of intensive therapy on the risk of retinopathy complications in patients with type 1 diabetes mellitus: 10 years after the Diabetes Control and Complications Trial

Neil H White, Wanjie Sun, Patricia A Cleary, Ronald P Danis, Matthew D Davis, Dean P Hainsworth, Larry D Hubbard, John M Lachin, David M Nathan and Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group

Archives of ophthalmology (1960), Vol.126(12), pp.1707-1715

12/2008

DOI: 10.1001/archopht.126.12.1707

PMCID: PMC2663518

PMID: 19064853

Files and links (1)

url

https://doi.org/10.1001/archopht.126.12.1707View

Published (Version of record) Open Access

Abstract

To examine the persistence of the original treatment effects 10 years after the Diabetes Control and Complications Trial (DCCT) in the follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study. In the DCCT, intensive therapy aimed at near-normal glycemia reduced the risk of microvascular complications of type 1 diabetes mellitus compared with conventional therapy. Retinopathy was evaluated by fundus photography in 1211 subjects at EDIC year 10. Further 3-step progression on the Early Treatment Diabetic Retinopathy Study scale from DCCT closeout was the primary outcome. After 10 years of EDIC follow-up, there was no significant difference in mean glycated hemoglobin levels (8.07% vs 7.98%) between the original treatment groups. Nevertheless, compared with the former conventional treatment group, the former intensive group had significantly lower incidences from DCCT close of further retinopathy progression and proliferative retinopathy or worse (hazard reductions, 53%-56%; P < .001). The risk (hazard) reductions at 10 years of EDIC were attenuated compared with the 70% to 71% over the first 4 years of EDIC (P < .001). The persistent beneficial effects of former intensive therapy were largely explained by the difference in glycated hemoglobin levels during DCCT. The persistent difference in diabetic retinopathy between former intensive and conventional therapy ("metabolic memory") continues for at least 10 years but may be waning. (clinicaltrials.gov) Identifiers: NCT00360815 and NCT00360893.

Glycated Hemoglobin A - analysis

Prevalence

Blood Glucose - analysis

Follow-Up Studies

Infusion Pumps

Humans

Risk Factors

Insulin - administration & dosage

Male

Diabetes Mellitus, Type 1 - complications

Disease Progression

Diabetes Mellitus, Type 1 - drug therapy

Incidence

Diabetic Retinopathy - physiopathology

Young Adult

Diabetic Retinopathy - epidemiology

Hypoglycemic Agents - administration & dosage

Diabetes Mellitus, Type 1 - blood

Adolescent

Adult

Female

Diabetic Retinopathy - etiology

Details

Title: Subtitle: Prolonged effect of intensive therapy on the risk of retinopathy complications in patients with type 1 diabetes mellitus: 10 years after the Diabetes Control and Complications Trial
Creators: Neil H White - Diabetes Unit, Massachusetts General Hospital, Boston, MA 02114, USA
Wanjie Sun
Patricia A Cleary
Ronald P Danis
Matthew D Davis
Dean P Hainsworth
Larry D Hubbard
John M Lachin
David M Nathan
Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group
Contributors: Edwin M Stone (Contributor) - University of Iowa, Ophthalmology and Visual Sciences
Resource Type: Journal article
Publication Details: Archives of ophthalmology (1960), Vol.126(12), pp.1707-1715
DOI: 10.1001/archopht.126.12.1707
PMID: 19064853
PMCID: PMC2663518
NLM abbreviation: Arch Ophthalmol
ISSN: 0003-9950
eISSN: 1538-3601
Publisher: American Medical Association; United States
Grant note: U10 EY014229-07 / NEI NIH HHS N01 DK062204-007 / NIDDK NIH HHS
Language: English
Date published: 12/2008
Academic Unit: Iowa Neuroscience Institute; Ophthalmology and Visual Sciences
Record Identifier: 9984070746802771

Metrics

14 Record Views

277 Times Cited - Web of Science

See more details