An observational study of the equivalence of age and duration of diabetes to glycemic control relative to the risk of complications in the combined cohorts of the DCCT/EDIC study

Authors

Ionut Bebu, The George Washington University
Barbara H. Braffett, The George Washington University
David Schade, The University of New Mexico
William Sivitz, University of Iowa
John I. Malone, University of South Florida, Tampa
Rodica Pop-Busui, University of Michigan, Ann Arbor
Gayle M. Lorenzi, University of California, San Diego
Pearl Lee, University of Michigan, Ann Arbor
Victoria R. Trapani, The George Washington University
Amisha Wallia, Northwestern University
William H. Herman, University of Michigan, Ann Arbor
John M. Lachin, The George Washington University

Document Type

Journal Article

Publication Date

10-1-2020

Journal

Diabetes Care

Volume

43

Issue

10

DOI

10.2337/dc20-0226

Abstract

OBJECTIVE This epidemiological analysis of the pooled Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) cohort describes the equivalence of a 1-percentage point increase in HbA1c (such as from 7% to 8%) and years of additional age or duration of type 1 diabetes (T1D) relative to the risk of complications. RESEARCH DESIGN AND METHODS Separate Cox proportional hazards models determined the number of additional years of age and/or duration of T1D that would result in the same increase in risk of microvascular (retinopathy, nephropathy, and neuropathy) and cardiovascular complications and mortality as a 1-percentage point increase in HbA1c. RESULTS The risk of any cardiovascular disease associated with a 1-percentage point increase in HbA1c was equivalent to the risk associated with 4.3 (95% CI 2.7–5.9) additional years of age or 5.6 (95% CI 2.7–6.5) additional years’ duration of T1D. The risk of estimated glomerular filtration rate <60 mL/min/1.73 m2 and/or end-stage renal disease associated with a 1-percentage point increase in HbA1c was equivalent to the risk associated with 12.1 (95% CI 8.3–15.9) additional years of age or 18.0 (95% CI 4.3–31.7) additional years’ duration of T1D. The proliferative diabetic retinopathy risk associated with a 1-percentage point increase in HbA1c was equivalent to the risk associated with 6.4 (95% CI 5.3–7.4) additional years’ duration of T1D, while for mortality risk, it was equivalent to the risk associated with 12.9 (95% CI 6.6–19.3) additional years of age. CONCLUSIONS Our resultshelp evaluatethe impact ofglycemia onadvanced complications in a way that may be more interpretable to health care providers and individuals with T1D.

APA Citation

Bebu, I., Braffett, B., Schade, D., Sivitz, W., Malone, J., Pop-Busui, R., Lorenzi, G., Lee, P., Trapani, V., Wallia, A., Herman, W., & Lachin, J. (2020). An observational study of the equivalence of age and duration of diabetes to glycemic control relative to the risk of complications in the combined cohorts of the DCCT/EDIC study. Diabetes Care, 43 (10). http://dx.doi.org/10.2337/dc20-0226