Relationships Between the Cumulative Incidences of Long-term Complications in Type 1 Diabetes: the DCCT/EDIC Study

Authors

Ionut Bebu, Biostatistics Center, The George Washington University, Rockville, MD.
Barbara H. Braffett, Biostatistics Center, The George Washington University, Rockville, MD.
Ian H. de Boer, Division of Nephrology, University of Washington, Seattle, WA.
Lloyd P. Aiello, Department of Ophthalmology, Joslin Diabetes Center, Boston, MA.
John P. Bantle, Department of Medicine, University of Minnesota, Minneapolis, MN.
Gayle M. Lorenzi, Department of Medicine, University of California San Diego, La Jolla, CA.
William H. Herman, Schools of Medicine and Public Health, University of Michigan, MI.
Rose A. Gubitosi-Klug, School of Medicine, Case Western Reserve University, Cleveland, OH.
Bruce A. Perkins, Division of Endocrinology and Metabolism, University of Toronto, Canada.
John M. Lachin, Biostatistics Center, The George Washington University, Rockville, MD.
Mark E. Molitch, Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Medicine, Northwestern University, Chicago, IL.

Document Type

Journal Article

Publication Date

12-15-2022

Journal

Diabetes care

DOI

10.2337/dc22-1744

Abstract

OBJECTIVE: To describe the relationships between the cumulative incidences of long-term complications in individuals with type 1 diabetes (T1D) and assess whether observed associations are independent of age, duration of diabetes, and glycemic levels. METHODS: Proliferative diabetic retinopathy (PDR), clinically significant macular edema (CSME), reduced estimated glomerular filtration rate (eGFR), amputations, cardiovascular disease (CVD), and mortality were assessed in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study over ∼30 years. RESEARCH DESIGN AND RESULTS: The cumulative incidence of complications ranged from 3% (amputations) to 37% (CSME). There were large differences in the cumulative incidence of PDR between participants with versus without prior CSME (66% vs. 15%), reduced eGFR (59% vs. 29%), and amputation (68% vs. 32%); reduced eGFR with or without prior PDR (25% vs. 9%), amputation (48% vs. 13%), and CVD (30% vs. 11%); CVD with or without prior reduced eGFR (37% vs. 14%) and amputation (50% vs. 16%); and mortality with or without prior reduced eGFR (22% vs. 9%), amputation (35% vs. 8%), and CVD (25% vs. 8%). Adjusted for age, duration of T1D, and mean updated HbA1c, the complications and associations with higher risk included PDR with CSME (hazard ratio [HR] 1.88; 95% CI 1.42, 2.50), reduced eGFR (HR 1.41; 95% CI 1.01, 1.97), and CVD (HR 1.43; 95% CI 1.06, 1.92); CSME with higher risk of PDR (HR 3.94; 95% CI 3.18 4.89), reduced eGFR (HR 1.49; 95% CI 1.10, 2.01), and CVD (HR 1.35; 95% CI 1.03, 1.78); reduced eGFR with higher risk of CVD (HR 2.09; 95% CI 1.44, 3.03), and death (HR 3.40; 95% CI 2.35, 4.92); amputation(s) with death (HR 2.97; 95% CI 1.70, 2.90); and CVD with reduced eGFR (HR 1.59; 95% CI 1.08, 2.34) and death (HR 1.95; 95% CI 1.32, 2.90). CONCLUSIONS: Long-term micro- and macrovascular complications and mortality are highly correlated. Age, diabetes duration, and glycemic levels do not completely explain these associations.

APA Citation

Bebu, Ionut; Braffett, Barbara H.; de Boer, Ian H.; Aiello, Lloyd P.; Bantle, John P.; Lorenzi, Gayle M.; Herman, William H.; Gubitosi-Klug, Rose A.; Perkins, Bruce A.; Lachin, John M.; and Molitch, Mark E., "Relationships Between the Cumulative Incidences of Long-term Complications in Type 1 Diabetes: the DCCT/EDIC Study" (2022). GW Authored Works. Paper 2095.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2095

Department

Biostatistics and Bioinformatics