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)
Open accessAbstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: The frequencies of serious complications in patients with T1DM, especially when treated intensively, are lower than that reported historically.
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The benefit of intensive glycemic management in the EDIC cohort of people with type 1 diabetes has been shown to persist for 30 years and was associated with a 32% reduction in cardiovascular disease events.
“The benefit of intensive glycemic management in the EDIC cohort of people with type 1 diabetes has been shown to persist for 30 years and was associated with a 32% reduction in CVD events (59).”
From 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026. (2026) · cites this paper as [59]
The Results—Long-Term Complications section (page unavailable) reports a lasting benefit after 30 years of diabetes: CVD incidence was 9% in the original intensive-treatment group versus 14% in the conventional-treatment group. That is approximately a 36% relative reduction, not the claimed 32%. The 30 years refers to diabetes duration, not 30 years of EDIC follow-up. (LLM, conf=0.88)
Experimental — accuracy not yet measuredLonger-term epidemiological follow-up of these studies also showed a pattern of cardiovascular disease benefit.
“Additionally, longer-term epidemiological follow-up of these studies also showed a pattern of CVD benefit (58-60).”
From 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026. (2026) · cites this paper as [59]
The benefit of intensive glycemic control in the type 1 diabetes cohort has been shown to persist for several decades and to be associated with a modest reduction in all-cause mortality.
“The benefit of intensive glycemic control in this cohort with type 1 diabetes has been shown to persist for several decades (55) and to be associated with a modest reduction in all-cause mortality (56).”
From 6. Glycemic Targets: <i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [55]
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- Authors
- Control, D.
- Affiliations
- Harvard University (US)
- Corresponding author
- Diabetes Control
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2009-07-27
- Volume
- 169
- Issue
- 14
- Pages
- 1307
- ISSN
- 0003-9926 (ISSN-L)
- PMC
- PMC2866072
- OpenAlex
- W2131363230
- Cited by
- 653
- References
- 30
- Citations by year
- 2026: 14 · 2025: 21 · 2024: 23 · 2023: 25 · 2022: 28 · 2021: 30 · 2020: 39 · 2019: 45 · 2018: 40 · 2017: 37 · 2016: 37 · 2015: 37 · 2014: 51 · 2013: 60 · 2012: 60
- FWCI
- 39.93
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Research Portal (Queen's University Belfast) (submittedVersion)
- Funders
- National Institutes of Health (n01dk062204-003)
- National Institute of Diabetes and Digestive and Kidney Diseases (R37DK034818, DK034818, N01 DK062204, R01DK034818)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- type 1 diabetes, intensive insulin therapy, conventional insulin therapy, late complications, proliferative retinopathy, diabetic nephropathy, cardiovascular disease, diabetic blindness, amputation, cumulative incidence, Diabetes Control and Complications Trial
- MeSH terms
- Adolescent, Adult, Blood Glucose, Canada, Diabetes Mellitus, Type 1, Humans, Hypoglycemia, Insulin, Longitudinal Studies, Middle Aged, United States, Weight Gain, Randomized Controlled Trials as Topic, Diabetic Ketoacidosis, Diabetes Complications, Young Adult
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