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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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Diabetes Control·2009·Archives of Internal Medicine

Abstract

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)

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  • Longer-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).”
  • 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).”

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Research works printed but not linked: 2

  1. [6]Writing Team for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group Sustained effect of intensive treatment of type 1 diabetes mellitus on development and progression of diabetic nephropathy: the Epidemiology of Diabetes Interventions and Complications (EDIC) study JAMA 2003 290 16 2159 2167 14570951 PMC2622725
  2. [24]The Diabetes Control and Complications Trial Research Group The effect of intensive diabetes treatment on the progression of diabetic retinopathy in insulin-dependent diabetes mellitus: the Diabetes Control and Complications Trial Arch Ophthalmol 1995 113 1 36 51 7826293

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Authors
Control, D.
Affiliations
Harvard University (US)
Corresponding author
Diabetes Control
Venue
Archives of Internal Medicine
Published
2009-07-27
Volume
169
Issue
14
Pages
1307
ISSN
0003-9926 (ISSN-L)
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
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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