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, O. Crofford, J. Crandall, M. Phillips, M. Reid, J. Brown-Friday, S. Engel, J. Sheindlin, H. Martinez, H. Shamoon, H. Engel, W. Dahms & 317 others M. Palmert, R. Gubitosi-Klug, L. Mayer, S. Pendegras, H. Zegarra, D. Miller, L. Singerman, S. Smith-Brewer, M. Novak, P. Gaston, S. Genuth, D. Brillon, M. E. Lackaye, V. Reppucci, T. Lee, M. Heinemann, F. Whitehouse, M. McLellan, D. Kruger, J. D. Carey, E. Angus, M. Croswell, A. Galpirn, R. Bergenstal, M. Johnson, M. Spencer, K. Morgan, D. Etzwiler, D. Kendall, D. Noller, A. Jacobson, E. Golden, R. Beaser, O. Ganda, O. Hamdy, J. Rosenzweig, H. Wolpert, P. G. Sharuk, P. Arrigg, A. Burwood, L. Rand, D. M. Nathan, M. Larkin, J. Godine, D. Moore, E. Cagliero, P. Lou, S. Fritz, J. Service, G. Ziegler, J. Pach, R. Colligan, M. Lopes-Virella, J. Colwell, K. Hermayer, M. Brabham, J. Soule, A. Blevins, J. Parker, D. Lee, P. Lindsey, M. Bracey, K. Lee, M. Nutaitis, A. Farr, S. Elsing, T. Thompson, J. Selby, T. Lyons, S. Yacoub-Wasef, M. Szpiech, D. Wood, R. Mayfield, M. Molitch, B. Schaefer, L. Jampol, A. Lyon, M. Gill, Z. Strugula, L. Kaminski, J. Shankle, P. Astlesford, D. Blackburn, S. Ajroud-Driss, O. Stone, C. West, I. Burnett-Zeigler, O. Kolterman, G. Lorenzi, M. Goldbaum, K. Harvey, H. Ferreyra, W. Sivitz, M. Bayless, T. Weingeist, E. Stone, H. Culver Boldt, K. Gehres, S. Russell, J. Bayless, J. Kramer, J. Long, R. Zeither, M. Hebdon, T. Donner, S. Johnsonbaugh, J. Gordon, R. Hemady, A. Kowarski, D. Ostrowski, S. Steidl, B. Jones, D. Counts, W. Herman, C. Martin, R. Pop-Busui, A. K. Vine, S. Elner, E. Feldman, J. Albers, D. Greene, M. J. Stevens, J. Bantle, B. Rogness, T. Olsen, E. Steuer, P. Rath, D. Hainsworth, S. Hitt, J. Giangiacom, D. Goldstein, D. Schade, J. Canady, J. M. Schluter, A. Das, D. Hornbeck, S. Schwartz, P. A. Bourne, B. J. Maschak-Carey, L. Baker, S. Braunstein, A. Brucker, T. Orchard, N. Silvers, C. Ryan, T. Songer, B. Doft, S. Olson, R. L. Bergren, L. Lobes, P. Paczan Rath, D. Becker, A. Drash, A. Morrison, J. Vaccaro-Kish, M. L. Bernal, J. Malone, P. R. Pavan, N. Grove, M. N. Iyer, A. F. Burrows, E. A. Tanaka, R. Gstalder, S. Dagogo-Jack, C. Wigley, H. Ricks, A. Kitabchi, M. B. Murphy, S. Moser, D. Meyer, A. Iannacone, E. Chaum, S. Yoser, M. Bryer-Ash, S. Schussler, H. Lambeth, Philip Raskin, S. Strowig, Rafael Ufret-Vincenty, Yu-Guang He, A. Edwards, J. Alappatt, C. Wilson, S. Park, B. Zinman, A. Barnie, S. MacLean, R. Devenyi, M. Mandelcorn, M. Brent, S. Rogers, A. Gordon, J. Palmer, S. Catton, J. Brunzell, J. Ginsberg, J. Kinyoun, L. Van Ottingham, J. Dupre, J. Harth, D. Nicolle, C. Canny, M. May, J. Lipps, A. Agarwal, T. Adkins, L. Survant, R. Lorenz, S. Feman, N. White, L. Levandoski, I. Boniuk, G. Grand, M. Thomas, D. Burgess, D. Joseph, K. Blinder, G. Shah, J. Santiago, W. Tamborlane, P. Gatcomb, K. Stoessel, K. Taylor, R. Trail, J. Quin, M. Lachin, P. Cleary, D. Kenny, J. Backlund, W. Sun, B. Rutledge, B. Waberski, K. Klumpp, K. Chan, L. Diminick, D. Rosenberg, B. Petty, A. Determan, C. Williams, L. Dews, M. Hawkins, C. Cowie, J. Fradkin, C. Siebert, R. Eastman, R. Danis, M. Davis, L. Hubbard, P. Geithman, L. Kastorff, M. Neider, D. Badal, B. Esser, K. Miner, H. Wabers, K. Glander, J. Joyce, N. Robinson, C. Hurtenbach, C. Hannon, M. Steffes, J. Bucksa, B. Chavers, D. O'Leary, L. Funk, J. Polak, A. Harrington, R. Crow, B. Gloeb, S. Thomas, C. O'Donnell, R. Prineas, C. Campbell, D. Sandstrom, T. Williams, M. Geckle, E. Cupelli, F. Thoma, B. Burzuk, T. Woodfill, P. Low, C. Sommer, K. Nickander, R. Detrano, N. Wong, M. Fox, L. Kim, R. Oudiz, G. Weir, C. Clark, R. D'Agostino, M. Espeland, B. Klein, T. Manolio, D. Singer, M. Stern, W. T. Garvey, T. J. Lyons, A. Jenkins, R. Klein, G. Virella, A. A. Jaffa, D. Lackland, D. McGee, D. Zheng, R. K. Mayfield, A. Paterson, A. Boright, S. Bull, L. Sun, S. Scherer, J. Hokanson, S. Marcovina, J. Purnell, S. Sibley, S. Deeb, K. Edwards

Research output: Contribution to journalArticle

239 Citations (Scopus)

Abstract

Objective: 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 nearnormal glycemia reduced the risk of microvascular complications of type 1 diabetes mellitus compared with conventional therapy. Methods: 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. Results: 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. Conclusion: The persistent difference in diabetic retinopathy between former intensive and conventional therapy ("metabolic memory") continues for at least 10 years but may be waning. Trial Registration: clinicaltrials.gov Identifiers: NCT00360815 and NCT00360893.

Original languageEnglish (US)
Pages (from-to)1707-1715
Number of pages9
JournalArchives of Ophthalmology
Volume126
Issue number12
DOIs
StatePublished - Dec 2008

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Diabetes Complications
Type 1 Diabetes Mellitus
Epidemiology
Therapeutics
Glycosylated Hemoglobin A
Diabetic Retinopathy
Photography
Risk Reduction Behavior

ASJC Scopus subject areas

  • Ophthalmology

Cite this

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. / White, Neil H.; Sun, Wanjie; Cleary, Patricia A.; Danis, Ronald P.; Davis, Matthew D.; Hainsworth, Dean P.; Hubbard, Larry D.; Lachin, John M.; Nathan, David M.; Crofford, O.; Crandall, J.; Phillips, M.; Reid, M.; Brown-Friday, J.; Engel, S.; Sheindlin, J.; Martinez, H.; Shamoon, H.; Engel, H.; Dahms, W.; Palmert, M.; Gubitosi-Klug, R.; Mayer, L.; Pendegras, S.; Zegarra, H.; Miller, D.; Singerman, L.; Smith-Brewer, S.; Novak, M.; Gaston, P.; Genuth, S.; Brillon, D.; Lackaye, M. E.; Reppucci, V.; Lee, T.; Heinemann, M.; Whitehouse, F.; McLellan, M.; Kruger, D.; Carey, J. D.; Angus, E.; Croswell, M.; Galpirn, A.; Bergenstal, R.; Johnson, M.; Spencer, M.; Morgan, K.; Etzwiler, D.; Kendall, D.; Noller, D.; Jacobson, A.; Golden, E.; Beaser, R.; Ganda, O.; Hamdy, O.; Rosenzweig, J.; Wolpert, H.; Sharuk, P. G.; Arrigg, P.; Burwood, A.; Rand, L.; Nathan, D. M.; Larkin, M.; Godine, J.; Moore, D.; Cagliero, E.; Lou, P.; Fritz, S.; Service, J.; Ziegler, G.; Pach, J.; Colligan, R.; Lopes-Virella, M.; Colwell, J.; Hermayer, K.; Brabham, M.; Soule, J.; Blevins, A.; Parker, J.; Lee, D.; Lindsey, P.; Bracey, M.; Lee, K.; Nutaitis, M.; Farr, A.; Elsing, S.; Thompson, T.; Selby, J.; Lyons, T.; Yacoub-Wasef, S.; Szpiech, M.; Wood, D.; Mayfield, R.; Molitch, M.; Schaefer, B.; Jampol, L.; Lyon, A.; Gill, M.; Strugula, Z.; Kaminski, L.; Shankle, J.; Astlesford, P.; Blackburn, D.; Ajroud-Driss, S.; Stone, O.; West, C.; Burnett-Zeigler, I.; Kolterman, O.; Lorenzi, G.; Goldbaum, M.; Harvey, K.; Ferreyra, H.; Sivitz, W.; Bayless, M.; Weingeist, T.; Stone, E.; Culver Boldt, H.; Gehres, K.; Russell, S.; Bayless, J.; Kramer, J.; Long, J.; Zeither, R.; Hebdon, M.; Donner, T.; Johnsonbaugh, S.; Gordon, J.; Hemady, R.; Kowarski, A.; Ostrowski, D.; Steidl, S.; Jones, B.; Counts, D.; Herman, W.; Martin, C.; Pop-Busui, R.; Vine, A. K.; Elner, S.; Feldman, E.; Albers, J.; Greene, D.; Stevens, M. J.; Bantle, J.; Rogness, B.; Olsen, T.; Steuer, E.; Rath, P.; Hainsworth, D.; Hitt, S.; Giangiacom, J.; Goldstein, D.; Schade, D.; Canady, J.; Schluter, J. M.; Das, A.; Hornbeck, D.; Schwartz, S.; Bourne, P. A.; Maschak-Carey, B. J.; Baker, L.; Braunstein, S.; Brucker, A.; Orchard, T.; Silvers, N.; Ryan, C.; Songer, T.; Doft, B.; Olson, S.; Bergren, R. L.; Lobes, L.; Paczan Rath, P.; Becker, D.; Drash, A.; Morrison, A.; Vaccaro-Kish, J.; Bernal, M. L.; Malone, J.; Pavan, P. R.; Grove, N.; Iyer, M. N.; Burrows, A. F.; Tanaka, E. A.; Gstalder, R.; Dagogo-Jack, S.; Wigley, C.; Ricks, H.; Kitabchi, A.; Murphy, M. B.; Moser, S.; Meyer, D.; Iannacone, A.; Chaum, E.; Yoser, S.; Bryer-Ash, M.; Schussler, S.; Lambeth, H.; Raskin, Philip; Strowig, S.; Ufret-Vincenty, Rafael; He, Yu-Guang; Edwards, A.; Alappatt, J.; Wilson, C.; Park, S.; Zinman, B.; Barnie, A.; MacLean, S.; Devenyi, R.; Mandelcorn, M.; Brent, M.; Rogers, S.; Gordon, A.; Palmer, J.; Catton, S.; Brunzell, J.; Ginsberg, J.; Kinyoun, J.; Van Ottingham, L.; Dupre, J.; Harth, J.; Nicolle, D.; Canny, C.; May, M.; Lipps, J.; Agarwal, A.; Adkins, T.; Survant, L.; Lorenz, R.; Feman, S.; White, N.; Levandoski, L.; Boniuk, I.; Grand, G.; Thomas, M.; Burgess, D.; Joseph, D.; Blinder, K.; Shah, G.; Santiago, J.; Tamborlane, W.; Gatcomb, P.; Stoessel, K.; Taylor, K.; Trail, R.; Quin, J.; Lachin, M.; Cleary, P.; Kenny, D.; Backlund, J.; Sun, W.; Rutledge, B.; Waberski, B.; Klumpp, K.; Chan, K.; Diminick, L.; Rosenberg, D.; Petty, B.; Determan, A.; Williams, C.; Dews, L.; Hawkins, M.; Cowie, C.; Fradkin, J.; Siebert, C.; Eastman, R.; Danis, R.; Davis, M.; Hubbard, L.; Geithman, P.; Kastorff, L.; Neider, M.; Badal, D.; Esser, B.; Miner, K.; Wabers, H.; Glander, K.; Joyce, J.; Robinson, N.; Hurtenbach, C.; Hannon, C.; Steffes, M.; Bucksa, J.; Chavers, B.; O'Leary, D.; Funk, L.; Polak, J.; Harrington, A.; Crow, R.; Gloeb, B.; Thomas, S.; O'Donnell, C.; Prineas, R.; Campbell, C.; Sandstrom, D.; Williams, T.; Geckle, M.; Cupelli, E.; Thoma, F.; Burzuk, B.; Woodfill, T.; Low, P.; Sommer, C.; Nickander, K.; Detrano, R.; Wong, N.; Fox, M.; Kim, L.; Oudiz, R.; Weir, G.; Clark, C.; D'Agostino, R.; Espeland, M.; Klein, B.; Manolio, T.; Singer, D.; Stern, M.; Garvey, W. T.; Lyons, T. J.; Jenkins, A.; Klein, R.; Virella, G.; Jaffa, A. A.; Lackland, D.; McGee, D.; Zheng, D.; Mayfield, R. K.; Paterson, A.; Boright, A.; Bull, S.; Sun, L.; Scherer, S.; Hokanson, J.; Marcovina, S.; Purnell, J.; Sibley, S.; Deeb, S.; Edwards, K.

In: Archives of Ophthalmology, Vol. 126, No. 12, 12.2008, p. 1707-1715.

Research output: Contribution to journalArticle

White, NH, Sun, W, Cleary, PA, Danis, RP, Davis, MD, Hainsworth, DP, Hubbard, LD, Lachin, JM, Nathan, DM, Crofford, O, Crandall, J, Phillips, M, Reid, M, Brown-Friday, J, Engel, S, Sheindlin, J, Martinez, H, Shamoon, H, Engel, H, Dahms, W, Palmert, M, Gubitosi-Klug, R, Mayer, L, Pendegras, S, Zegarra, H, Miller, D, Singerman, L, Smith-Brewer, S, Novak, M, Gaston, P, Genuth, S, Brillon, D, Lackaye, ME, Reppucci, V, Lee, T, Heinemann, M, Whitehouse, F, McLellan, M, Kruger, D, Carey, JD, Angus, E, Croswell, M, Galpirn, A, Bergenstal, R, Johnson, M, Spencer, M, Morgan, K, Etzwiler, D, Kendall, D, Noller, D, Jacobson, A, Golden, E, Beaser, R, Ganda, O, Hamdy, O, Rosenzweig, J, Wolpert, H, Sharuk, PG, Arrigg, P, Burwood, A, Rand, L, Nathan, DM, Larkin, M, Godine, J, Moore, D, Cagliero, E, Lou, P, Fritz, S, Service, J, Ziegler, G, Pach, J, Colligan, R, Lopes-Virella, M, Colwell, J, Hermayer, K, Brabham, M, Soule, J, Blevins, A, Parker, J, Lee, D, Lindsey, P, Bracey, M, Lee, K, Nutaitis, M, Farr, A, Elsing, S, Thompson, T, Selby, J, Lyons, T, Yacoub-Wasef, S, Szpiech, M, Wood, D, Mayfield, R, Molitch, M, Schaefer, B, Jampol, L, Lyon, A, Gill, M, Strugula, Z, Kaminski, L, Shankle, J, Astlesford, P, Blackburn, D, Ajroud-Driss, S, Stone, O, West, C, Burnett-Zeigler, I, Kolterman, O, Lorenzi, G, Goldbaum, M, Harvey, K, Ferreyra, H, Sivitz, W, Bayless, M, Weingeist, T, Stone, E, Culver Boldt, H, Gehres, K, Russell, S, Bayless, J, Kramer, J, Long, J, Zeither, R, Hebdon, M, Donner, T, Johnsonbaugh, S, Gordon, J, Hemady, R, Kowarski, A, Ostrowski, D, Steidl, S, Jones, B, Counts, D, Herman, W, Martin, C, Pop-Busui, R, Vine, AK, Elner, S, Feldman, E, Albers, J, Greene, D, Stevens, MJ, Bantle, J, Rogness, B, Olsen, T, Steuer, E, Rath, P, Hainsworth, D, Hitt, S, Giangiacom, J, Goldstein, D, Schade, D, Canady, J, Schluter, JM, Das, A, Hornbeck, D, Schwartz, S, Bourne, PA, Maschak-Carey, BJ, Baker, L, Braunstein, S, Brucker, A, Orchard, T, Silvers, N, Ryan, C, Songer, T, Doft, B, Olson, S, Bergren, RL, Lobes, L, Paczan Rath, P, Becker, D, Drash, A, Morrison, A, Vaccaro-Kish, J, Bernal, ML, Malone, J, Pavan, PR, Grove, N, Iyer, MN, Burrows, AF, Tanaka, EA, Gstalder, R, Dagogo-Jack, S, Wigley, C, Ricks, H, Kitabchi, A, Murphy, MB, Moser, S, Meyer, D, Iannacone, A, Chaum, E, Yoser, S, Bryer-Ash, M, Schussler, S, Lambeth, H, Raskin, P, Strowig, S, Ufret-Vincenty, R, He, Y-G, Edwards, A, Alappatt, J, Wilson, C, Park, S, Zinman, B, Barnie, A, MacLean, S, Devenyi, R, Mandelcorn, M, Brent, M, Rogers, S, Gordon, A, Palmer, J, Catton, S, Brunzell, J, Ginsberg, J, Kinyoun, J, Van Ottingham, L, Dupre, J, Harth, J, Nicolle, D, Canny, C, May, M, Lipps, J, Agarwal, A, Adkins, T, Survant, L, Lorenz, R, Feman, S, White, N, Levandoski, L, Boniuk, I, Grand, G, Thomas, M, Burgess, D, Joseph, D, Blinder, K, Shah, G, Santiago, J, Tamborlane, W, Gatcomb, P, Stoessel, K, Taylor, K, Trail, R, Quin, J, Lachin, M, Cleary, P, Kenny, D, Backlund, J, Sun, W, Rutledge, B, Waberski, B, Klumpp, K, Chan, K, Diminick, L, Rosenberg, D, Petty, B, Determan, A, Williams, C, Dews, L, Hawkins, M, Cowie, C, Fradkin, J, Siebert, C, Eastman, R, Danis, R, Davis, M, Hubbard, L, Geithman, P, Kastorff, L, Neider, M, Badal, D, Esser, B, Miner, K, Wabers, H, Glander, K, Joyce, J, Robinson, N, Hurtenbach, C, Hannon, C, Steffes, M, Bucksa, J, Chavers, B, O'Leary, D, Funk, L, Polak, J, Harrington, A, Crow, R, Gloeb, B, Thomas, S, O'Donnell, C, Prineas, R, Campbell, C, Sandstrom, D, Williams, T, Geckle, M, Cupelli, E, Thoma, F, Burzuk, B, Woodfill, T, Low, P, Sommer, C, Nickander, K, Detrano, R, Wong, N, Fox, M, Kim, L, Oudiz, R, Weir, G, Clark, C, D'Agostino, R, Espeland, M, Klein, B, Manolio, T, Singer, D, Stern, M, Garvey, WT, Lyons, TJ, Jenkins, A, Klein, R, Virella, G, Jaffa, AA, Lackland, D, McGee, D, Zheng, D, Mayfield, RK, Paterson, A, Boright, A, Bull, S, Sun, L, Scherer, S, Hokanson, J, Marcovina, S, Purnell, J, Sibley, S, Deeb, S & Edwards, K 2008, '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', Archives of Ophthalmology, vol. 126, no. 12, pp. 1707-1715. https://doi.org/10.1001/archopht.126.12.1707
White, Neil H. ; Sun, Wanjie ; Cleary, Patricia A. ; Danis, Ronald P. ; Davis, Matthew D. ; Hainsworth, Dean P. ; Hubbard, Larry D. ; Lachin, John M. ; Nathan, David M. ; Crofford, O. ; Crandall, J. ; Phillips, M. ; Reid, M. ; Brown-Friday, J. ; Engel, S. ; Sheindlin, J. ; Martinez, H. ; Shamoon, H. ; Engel, H. ; Dahms, W. ; Palmert, M. ; Gubitosi-Klug, R. ; Mayer, L. ; Pendegras, S. ; Zegarra, H. ; Miller, D. ; Singerman, L. ; Smith-Brewer, S. ; Novak, M. ; Gaston, P. ; Genuth, S. ; Brillon, D. ; Lackaye, M. E. ; Reppucci, V. ; Lee, T. ; Heinemann, M. ; Whitehouse, F. ; McLellan, M. ; Kruger, D. ; Carey, J. D. ; Angus, E. ; Croswell, M. ; Galpirn, A. ; Bergenstal, R. ; Johnson, M. ; Spencer, M. ; Morgan, K. ; Etzwiler, D. ; Kendall, D. ; Noller, D. ; Jacobson, A. ; Golden, E. ; Beaser, R. ; Ganda, O. ; Hamdy, O. ; Rosenzweig, J. ; Wolpert, H. ; Sharuk, P. G. ; Arrigg, P. ; Burwood, A. ; Rand, L. ; Nathan, D. M. ; Larkin, M. ; Godine, J. ; Moore, D. ; Cagliero, E. ; Lou, P. ; Fritz, S. ; Service, J. ; Ziegler, G. ; Pach, J. ; Colligan, R. ; Lopes-Virella, M. ; Colwell, J. ; Hermayer, K. ; Brabham, M. ; Soule, J. ; Blevins, A. ; Parker, J. ; Lee, D. ; Lindsey, P. ; Bracey, M. ; Lee, K. ; Nutaitis, M. ; Farr, A. ; Elsing, S. ; Thompson, T. ; Selby, J. ; Lyons, T. ; Yacoub-Wasef, S. ; Szpiech, M. ; Wood, D. ; Mayfield, R. ; Molitch, M. ; Schaefer, B. ; Jampol, L. ; Lyon, A. ; Gill, M. ; Strugula, Z. ; Kaminski, L. ; Shankle, J. ; Astlesford, P. ; Blackburn, D. ; Ajroud-Driss, S. ; Stone, O. ; West, C. ; Burnett-Zeigler, I. ; Kolterman, O. ; Lorenzi, G. ; Goldbaum, M. ; Harvey, K. ; Ferreyra, H. ; Sivitz, W. ; Bayless, M. ; Weingeist, T. ; Stone, E. ; Culver Boldt, H. ; Gehres, K. ; Russell, S. ; Bayless, J. ; Kramer, J. ; Long, J. ; Zeither, R. ; Hebdon, M. ; Donner, T. ; Johnsonbaugh, S. ; Gordon, J. ; Hemady, R. ; Kowarski, A. ; Ostrowski, D. ; Steidl, S. ; Jones, B. ; Counts, D. ; Herman, W. ; Martin, C. ; Pop-Busui, R. ; Vine, A. K. ; Elner, S. ; Feldman, E. ; Albers, J. ; Greene, D. ; Stevens, M. J. ; Bantle, J. ; Rogness, B. ; Olsen, T. ; Steuer, E. ; Rath, P. ; Hainsworth, D. ; Hitt, S. ; Giangiacom, J. ; Goldstein, D. ; Schade, D. ; Canady, J. ; Schluter, J. M. ; Das, A. ; Hornbeck, D. ; Schwartz, S. ; Bourne, P. A. ; Maschak-Carey, B. J. ; Baker, L. ; Braunstein, S. ; Brucker, A. ; Orchard, T. ; Silvers, N. ; Ryan, C. ; Songer, T. ; Doft, B. ; Olson, S. ; Bergren, R. L. ; Lobes, L. ; Paczan Rath, P. ; Becker, D. ; Drash, A. ; Morrison, A. ; Vaccaro-Kish, J. ; Bernal, M. L. ; Malone, J. ; Pavan, P. R. ; Grove, N. ; Iyer, M. N. ; Burrows, A. F. ; Tanaka, E. A. ; Gstalder, R. ; Dagogo-Jack, S. ; Wigley, C. ; Ricks, H. ; Kitabchi, A. ; Murphy, M. B. ; Moser, S. ; Meyer, D. ; Iannacone, A. ; Chaum, E. ; Yoser, S. ; Bryer-Ash, M. ; Schussler, S. ; Lambeth, H. ; Raskin, Philip ; Strowig, S. ; Ufret-Vincenty, Rafael ; He, Yu-Guang ; Edwards, A. ; Alappatt, J. ; Wilson, C. ; Park, S. ; Zinman, B. ; Barnie, A. ; MacLean, S. ; Devenyi, R. ; Mandelcorn, M. ; Brent, M. ; Rogers, S. ; Gordon, A. ; Palmer, J. ; Catton, S. ; Brunzell, J. ; Ginsberg, J. ; Kinyoun, J. ; Van Ottingham, L. ; Dupre, J. ; Harth, J. ; Nicolle, D. ; Canny, C. ; May, M. ; Lipps, J. ; Agarwal, A. ; Adkins, T. ; Survant, L. ; Lorenz, R. ; Feman, S. ; White, N. ; Levandoski, L. ; Boniuk, I. ; Grand, G. ; Thomas, M. ; Burgess, D. ; Joseph, D. ; Blinder, K. ; Shah, G. ; Santiago, J. ; Tamborlane, W. ; Gatcomb, P. ; Stoessel, K. ; Taylor, K. ; Trail, R. ; Quin, J. ; Lachin, M. ; Cleary, P. ; Kenny, D. ; Backlund, J. ; Sun, W. ; Rutledge, B. ; Waberski, B. ; Klumpp, K. ; Chan, K. ; Diminick, L. ; Rosenberg, D. ; Petty, B. ; Determan, A. ; Williams, C. ; Dews, L. ; Hawkins, M. ; Cowie, C. ; Fradkin, J. ; Siebert, C. ; Eastman, R. ; Danis, R. ; Davis, M. ; Hubbard, L. ; Geithman, P. ; Kastorff, L. ; Neider, M. ; Badal, D. ; Esser, B. ; Miner, K. ; Wabers, H. ; Glander, K. ; Joyce, J. ; Robinson, N. ; Hurtenbach, C. ; Hannon, C. ; Steffes, M. ; Bucksa, J. ; Chavers, B. ; O'Leary, D. ; Funk, L. ; Polak, J. ; Harrington, A. ; Crow, R. ; Gloeb, B. ; Thomas, S. ; O'Donnell, C. ; Prineas, R. ; Campbell, C. ; Sandstrom, D. ; Williams, T. ; Geckle, M. ; Cupelli, E. ; Thoma, F. ; Burzuk, B. ; Woodfill, T. ; Low, P. ; Sommer, C. ; Nickander, K. ; Detrano, R. ; Wong, N. ; Fox, M. ; Kim, L. ; Oudiz, R. ; Weir, G. ; Clark, C. ; D'Agostino, R. ; Espeland, M. ; Klein, B. ; Manolio, T. ; Singer, D. ; Stern, M. ; Garvey, W. T. ; Lyons, T. J. ; Jenkins, A. ; Klein, R. ; Virella, G. ; Jaffa, A. A. ; Lackland, D. ; McGee, D. ; Zheng, D. ; Mayfield, R. K. ; Paterson, A. ; Boright, A. ; Bull, S. ; Sun, L. ; Scherer, S. ; Hokanson, J. ; Marcovina, S. ; Purnell, J. ; Sibley, S. ; Deeb, S. ; Edwards, K. / 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. In: Archives of Ophthalmology. 2008 ; Vol. 126, No. 12. pp. 1707-1715.
@article{2de54785d4214cf6b81ce7d1209317d1,
title = "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",
abstract = "Objective: 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 nearnormal glycemia reduced the risk of microvascular complications of type 1 diabetes mellitus compared with conventional therapy. Methods: 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. Results: 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. Conclusion: The persistent difference in diabetic retinopathy between former intensive and conventional therapy ({"}metabolic memory{"}) continues for at least 10 years but may be waning. Trial Registration: clinicaltrials.gov Identifiers: NCT00360815 and NCT00360893.",
author = "White, {Neil H.} and Wanjie Sun and Cleary, {Patricia A.} and Danis, {Ronald P.} and Davis, {Matthew D.} and Hainsworth, {Dean P.} and Hubbard, {Larry D.} and Lachin, {John M.} and Nathan, {David M.} and O. Crofford and J. Crandall and M. Phillips and M. Reid and J. Brown-Friday and S. Engel and J. Sheindlin and H. Martinez and H. Shamoon and H. Engel and W. Dahms and M. Palmert and R. Gubitosi-Klug and L. Mayer and S. Pendegras and H. Zegarra and D. Miller and L. Singerman and S. Smith-Brewer and M. Novak and P. Gaston and S. Genuth and D. Brillon and Lackaye, {M. E.} and V. Reppucci and T. Lee and M. Heinemann and F. Whitehouse and M. McLellan and D. Kruger and Carey, {J. D.} and E. Angus and M. Croswell and A. Galpirn and R. Bergenstal and M. Johnson and M. Spencer and K. Morgan and D. Etzwiler and D. Kendall and D. Noller and A. Jacobson and E. Golden and R. Beaser and O. Ganda and O. Hamdy and J. Rosenzweig and H. Wolpert and Sharuk, {P. G.} and P. Arrigg and A. Burwood and L. Rand and Nathan, {D. M.} and M. Larkin and J. Godine and D. Moore and E. Cagliero and P. Lou and S. Fritz and J. Service and G. Ziegler and J. Pach and R. Colligan and M. Lopes-Virella and J. Colwell and K. Hermayer and M. Brabham and J. Soule and A. Blevins and J. Parker and D. Lee and P. Lindsey and M. Bracey and K. Lee and M. Nutaitis and A. Farr and S. Elsing and T. Thompson and J. Selby and T. Lyons and S. Yacoub-Wasef and M. Szpiech and D. Wood and R. Mayfield and M. Molitch and B. Schaefer and L. Jampol and A. Lyon and M. Gill and Z. Strugula and L. Kaminski and J. Shankle and P. Astlesford and D. Blackburn and S. Ajroud-Driss and O. Stone and C. West and I. Burnett-Zeigler and O. Kolterman and G. Lorenzi and M. Goldbaum and K. Harvey and H. Ferreyra and W. Sivitz and M. Bayless and T. Weingeist and E. Stone and {Culver Boldt}, H. and K. Gehres and S. Russell and J. Bayless and J. Kramer and J. Long and R. Zeither and M. Hebdon and T. Donner and S. Johnsonbaugh and J. Gordon and R. Hemady and A. Kowarski and D. Ostrowski and S. Steidl and B. Jones and D. Counts and W. Herman and C. Martin and R. Pop-Busui and Vine, {A. K.} and S. Elner and E. Feldman and J. Albers and D. Greene and Stevens, {M. J.} and J. Bantle and B. Rogness and T. Olsen and E. Steuer and P. Rath and D. Hainsworth and S. Hitt and J. Giangiacom and D. Goldstein and D. Schade and J. Canady and Schluter, {J. M.} and A. Das and D. Hornbeck and S. Schwartz and Bourne, {P. A.} and Maschak-Carey, {B. J.} and L. Baker and S. Braunstein and A. Brucker and T. Orchard and N. Silvers and C. Ryan and T. Songer and B. Doft and S. Olson and Bergren, {R. L.} and L. Lobes and {Paczan Rath}, P. and D. Becker and A. Drash and A. Morrison and J. Vaccaro-Kish and Bernal, {M. L.} and J. Malone and Pavan, {P. R.} and N. Grove and Iyer, {M. N.} and Burrows, {A. F.} and Tanaka, {E. A.} and R. Gstalder and S. Dagogo-Jack and C. Wigley and H. Ricks and A. Kitabchi and Murphy, {M. B.} and S. Moser and D. Meyer and A. Iannacone and E. Chaum and S. Yoser and M. Bryer-Ash and S. Schussler and H. Lambeth and Philip Raskin and S. Strowig and Rafael Ufret-Vincenty and Yu-Guang He and A. Edwards and J. Alappatt and C. Wilson and S. Park and B. Zinman and A. Barnie and S. MacLean and R. Devenyi and M. Mandelcorn and M. Brent and S. Rogers and A. Gordon and J. Palmer and S. Catton and J. Brunzell and J. Ginsberg and J. Kinyoun and {Van Ottingham}, L. and J. Dupre and J. Harth and D. Nicolle and C. Canny and M. May and J. Lipps and A. Agarwal and T. Adkins and L. Survant and R. Lorenz and S. Feman and N. White and L. Levandoski and I. Boniuk and G. Grand and M. Thomas and D. Burgess and D. Joseph and K. Blinder and G. Shah and J. Santiago and W. Tamborlane and P. Gatcomb and K. Stoessel and K. Taylor and R. Trail and J. Quin and M. Lachin and P. Cleary and D. Kenny and J. Backlund and W. Sun and B. Rutledge and B. Waberski and K. Klumpp and K. Chan and L. Diminick and D. Rosenberg and B. Petty and A. Determan and C. Williams and L. Dews and M. Hawkins and C. Cowie and J. Fradkin and C. Siebert and R. Eastman and R. Danis and M. Davis and L. Hubbard and P. Geithman and L. Kastorff and M. Neider and D. Badal and B. Esser and K. Miner and H. Wabers and K. Glander and J. Joyce and N. Robinson and C. Hurtenbach and C. Hannon and M. Steffes and J. Bucksa and B. Chavers and D. O'Leary and L. Funk and J. Polak and A. Harrington and R. Crow and B. Gloeb and S. Thomas and C. O'Donnell and R. Prineas and C. Campbell and D. Sandstrom and T. Williams and M. Geckle and E. Cupelli and F. Thoma and B. Burzuk and T. Woodfill and P. Low and C. Sommer and K. Nickander and R. Detrano and N. Wong and M. Fox and L. Kim and R. Oudiz and G. Weir and C. Clark and R. D'Agostino and M. Espeland and B. Klein and T. Manolio and D. Singer and M. Stern and Garvey, {W. T.} and Lyons, {T. J.} and A. Jenkins and R. Klein and G. Virella and Jaffa, {A. A.} and D. Lackland and D. McGee and D. Zheng and Mayfield, {R. K.} and A. Paterson and A. Boright and S. Bull and L. Sun and S. Scherer and J. Hokanson and S. Marcovina and J. Purnell and S. Sibley and S. Deeb and K. Edwards",
year = "2008",
month = "12",
doi = "10.1001/archopht.126.12.1707",
language = "English (US)",
volume = "126",
pages = "1707--1715",
journal = "JAMA Ophthalmology",
issn = "2168-6165",
publisher = "American Medical Association",
number = "12",

}

TY - JOUR

T1 - Prolonged effect of intensive therapy on the risk of retinopathy complications in patients with type 1 diabetes mellitus

T2 - 10 years after the diabetes control and complications trial

AU - White, Neil H.

AU - Sun, Wanjie

AU - Cleary, Patricia A.

AU - Danis, Ronald P.

AU - Davis, Matthew D.

AU - Hainsworth, Dean P.

AU - Hubbard, Larry D.

AU - Lachin, John M.

AU - Nathan, David M.

AU - Crofford, O.

AU - Crandall, J.

AU - Phillips, M.

AU - Reid, M.

AU - Brown-Friday, J.

AU - Engel, S.

AU - Sheindlin, J.

AU - Martinez, H.

AU - Shamoon, H.

AU - Engel, H.

AU - Dahms, W.

AU - Palmert, M.

AU - Gubitosi-Klug, R.

AU - Mayer, L.

AU - Pendegras, S.

AU - Zegarra, H.

AU - Miller, D.

AU - Singerman, L.

AU - Smith-Brewer, S.

AU - Novak, M.

AU - Gaston, P.

AU - Genuth, S.

AU - Brillon, D.

AU - Lackaye, M. E.

AU - Reppucci, V.

AU - Lee, T.

AU - Heinemann, M.

AU - Whitehouse, F.

AU - McLellan, M.

AU - Kruger, D.

AU - Carey, J. D.

AU - Angus, E.

AU - Croswell, M.

AU - Galpirn, A.

AU - Bergenstal, R.

AU - Johnson, M.

AU - Spencer, M.

AU - Morgan, K.

AU - Etzwiler, D.

AU - Kendall, D.

AU - Noller, D.

AU - Jacobson, A.

AU - Golden, E.

AU - Beaser, R.

AU - Ganda, O.

AU - Hamdy, O.

AU - Rosenzweig, J.

AU - Wolpert, H.

AU - Sharuk, P. G.

AU - Arrigg, P.

AU - Burwood, A.

AU - Rand, L.

AU - Nathan, D. M.

AU - Larkin, M.

AU - Godine, J.

AU - Moore, D.

AU - Cagliero, E.

AU - Lou, P.

AU - Fritz, S.

AU - Service, J.

AU - Ziegler, G.

AU - Pach, J.

AU - Colligan, R.

AU - Lopes-Virella, M.

AU - Colwell, J.

AU - Hermayer, K.

AU - Brabham, M.

AU - Soule, J.

AU - Blevins, A.

AU - Parker, J.

AU - Lee, D.

AU - Lindsey, P.

AU - Bracey, M.

AU - Lee, K.

AU - Nutaitis, M.

AU - Farr, A.

AU - Elsing, S.

AU - Thompson, T.

AU - Selby, J.

AU - Lyons, T.

AU - Yacoub-Wasef, S.

AU - Szpiech, M.

AU - Wood, D.

AU - Mayfield, R.

AU - Molitch, M.

AU - Schaefer, B.

AU - Jampol, L.

AU - Lyon, A.

AU - Gill, M.

AU - Strugula, Z.

AU - Kaminski, L.

AU - Shankle, J.

AU - Astlesford, P.

AU - Blackburn, D.

AU - Ajroud-Driss, S.

AU - Stone, O.

AU - West, C.

AU - Burnett-Zeigler, I.

AU - Kolterman, O.

AU - Lorenzi, G.

AU - Goldbaum, M.

AU - Harvey, K.

AU - Ferreyra, H.

AU - Sivitz, W.

AU - Bayless, M.

AU - Weingeist, T.

AU - Stone, E.

AU - Culver Boldt, H.

AU - Gehres, K.

AU - Russell, S.

AU - Bayless, J.

AU - Kramer, J.

AU - Long, J.

AU - Zeither, R.

AU - Hebdon, M.

AU - Donner, T.

AU - Johnsonbaugh, S.

AU - Gordon, J.

AU - Hemady, R.

AU - Kowarski, A.

AU - Ostrowski, D.

AU - Steidl, S.

AU - Jones, B.

AU - Counts, D.

AU - Herman, W.

AU - Martin, C.

AU - Pop-Busui, R.

AU - Vine, A. K.

AU - Elner, S.

AU - Feldman, E.

AU - Albers, J.

AU - Greene, D.

AU - Stevens, M. J.

AU - Bantle, J.

AU - Rogness, B.

AU - Olsen, T.

AU - Steuer, E.

AU - Rath, P.

AU - Hainsworth, D.

AU - Hitt, S.

AU - Giangiacom, J.

AU - Goldstein, D.

AU - Schade, D.

AU - Canady, J.

AU - Schluter, J. M.

AU - Das, A.

AU - Hornbeck, D.

AU - Schwartz, S.

AU - Bourne, P. A.

AU - Maschak-Carey, B. J.

AU - Baker, L.

AU - Braunstein, S.

AU - Brucker, A.

AU - Orchard, T.

AU - Silvers, N.

AU - Ryan, C.

AU - Songer, T.

AU - Doft, B.

AU - Olson, S.

AU - Bergren, R. L.

AU - Lobes, L.

AU - Paczan Rath, P.

AU - Becker, D.

AU - Drash, A.

AU - Morrison, A.

AU - Vaccaro-Kish, J.

AU - Bernal, M. L.

AU - Malone, J.

AU - Pavan, P. R.

AU - Grove, N.

AU - Iyer, M. N.

AU - Burrows, A. F.

AU - Tanaka, E. A.

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PY - 2008/12

Y1 - 2008/12

N2 - Objective: 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 nearnormal glycemia reduced the risk of microvascular complications of type 1 diabetes mellitus compared with conventional therapy. Methods: 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. Results: 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. Conclusion: The persistent difference in diabetic retinopathy between former intensive and conventional therapy ("metabolic memory") continues for at least 10 years but may be waning. Trial Registration: clinicaltrials.gov Identifiers: NCT00360815 and NCT00360893.

AB - Objective: 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 nearnormal glycemia reduced the risk of microvascular complications of type 1 diabetes mellitus compared with conventional therapy. Methods: 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. Results: 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. Conclusion: The persistent difference in diabetic retinopathy between former intensive and conventional therapy ("metabolic memory") continues for at least 10 years but may be waning. Trial Registration: clinicaltrials.gov Identifiers: NCT00360815 and NCT00360893.

UR - http://www.scopus.com/inward/record.url?scp=58149252632&partnerID=8YFLogxK

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U2 - 10.1001/archopht.126.12.1707

DO - 10.1001/archopht.126.12.1707

M3 - Article

VL - 126

SP - 1707

EP - 1715

JO - JAMA Ophthalmology

JF - JAMA Ophthalmology

SN - 2168-6165

IS - 12

ER -