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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
Open accessAbstract
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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“Both DCCT/EDIC and UKPDS suggested that there is metabolic memory, or a legacy effect, in which a finite period of intensive glucose lowering yielded benefits that extended for decades after that period ended (44-48).”
From 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026. (2026) · cites this paper as [45]
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“Follow-up of the DCCT cohorts in the Epidemiology of Diabetes Interventions and Complications (EDIC) study (44,45) demonstrated persistence of these microvascular benefits over two decades despite the fact that the glycemic separation between the treatment groups diminished and disappeared during follow-up.”
From 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026. (2026) · cites this paper as [45]
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“Follow-up of the DCCT cohorts in the Epidemiology of Diabetes Interventions and Complications (EDIC) study (42,43) demonstrated persistence of these microvascular benefits over two decades despite the fact that the glycemic separation between the treatment groups diminished and disappeared during follow-up.”
From 6. Glycemic Targets: Standards of Care in Diabetes—2023 (2023) · cites this paper as [42]
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Metadata
- 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
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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