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Effect of Intensive Diabetes Therapy on the Progression of Diabetic Retinopathy in Patients With Type 1 Diabetes: 18 Years of Follow-up in the DCCT/EDIC

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The Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group·2015·Diabetes

DOI 10.2337/db14-0930PMC PMC4303965

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Abstract

The Diabetes Control and Complications Trial (DCCT) demonstrated that a mean of 6.5 years of intensive therapy aimed at near-normal glucose levels reduced the risk of development and progression of retinopathy by as much as 76% compared with conventional therapy. The Epidemiology of Diabetes Interventions and Complications study (EDIC) observational follow-up showed that the risk of further progression of retinopathy 4 years after the DCCT ended was also greatly reduced in the former intensive group, despite nearly equivalent levels of HbA1c, a phenomenon termed metabolic memory. Metabolic memory was shown to persist through 10 years of follow-up. We now describe the risk of further progression of retinopathy, progression to proliferative diabetic retinopathy, clinically significant macular edema, and the need for intervention (photocoagulation or anti-VEGF) over 18 years of follow-up in EDIC. The cumulative incidence of each retinal outcome continues to be lower in the former intensive group. However, the year-to-year incidence of these outcomes is now similar, owing in large part to a reduction in risk in the former conventional treatment group.

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Authors: The Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group
Corresponding author: The Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group
Venue: Diabetes
Publisher: American Diabetes Association
Published: 2014-09-09
Volume: 64
Issue: 2
Pages: 631-642
ISSN: 0012-1797 (ISSN-L)
1939-327X
DOI: 10.2337/db14-0930
PMC: PMC4303965
OpenAlex: W2173163930
Cited by: 333
References: 21
Citations by year: 2026: 19 · 2025: 23 · 2024: 23 · 2023: 26 · 2022: 36 · 2021: 34 · 2020: 32 · 2019: 29 · 2018: 25 · 2017: 36 · 2016: 23 · 2015: 27
FWCI: 26.81
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Diabetes (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (UL1TR000142)
National Institute of Diabetes and Digestive and Kidney Diseases (U01DK094176, P30DK092950)
National Center for Advancing Translational Sciences
Topics: Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords: diabetic retinopathy, type 1 diabetes, tight glycemic control, metabolic memory, retinopathy progression, proliferative diabetic retinopathy, clinically significant macular edema, photocoagulation, anti-VEGF therapy, long-term follow-up, DCCT/EDIC
MeSH terms: Adolescent, Adult, Aging, Diabetes Mellitus, Type 1, Diabetic Retinopathy, Drug Administration Schedule, Female, Glycated Hemoglobin, Humans, Insulin, Male, Middle Aged, Risk Factors, Young Adult

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Effect of Intensive Diabetes Therapy on the Progression of Diabetic Retinopathy in Patients With Type 1 Diabetes: 18 Years of Follow-up in the DCCT/EDIC

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