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 near-normal 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.
  
  
  CONCLUSIONS
  The persistent difference in diabetic retinopathy between former intensive and conventional therapy ("metabolic memory") continues for at least 10 years but may be waning.
  
  
  BACKGROUND
  (clinicaltrials.gov) Identifiers: NCT00360815 and NCT00360893.
authors.affiliation: Diabetes Unit, Massachusetts General Hospital, Boston, MA 02114, USA.
authors.forename: Neil H
authors.initials: NH
authors.lastname: White
authors.forename: Wanjie
authors.initials: W
authors.lastname: Sun
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Cleary
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Danis
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Davis
authors.forename: Dean P
authors.initials: DP
authors.lastname: Hainsworth
authors.forename: Larry D
authors.initials: LD
authors.lastname: Hubbard
authors.forename: John M
authors.initials: JM
authors.lastname: Lachin
authors.forename: David M
authors.initials: DM
authors.lastname: Nathan
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D003930:Diabetic Retinopathy / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D015994:Incidence; D007260:Infusion Pumps; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human