title: 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.
abstract: 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.
authors.forename: John M
authors.initials: JM
authors.lastname: Lachin
authors.forename: Neil H
authors.initials: NH
authors.lastname: White
authors.forename: Dean P
authors.initials: DP
authors.lastname: Hainsworth
authors.forename: Wanjie
authors.initials: W
authors.lastname: Sun
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Cleary
authors.forename: David M
authors.initials: DM
authors.lastname: Nathan
mesh_terms: D000293:Adolescent; D000328:Adult; D000375:Aging; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D003930:Diabetic Retinopathy / Q000473:pathology* / Q000517:prevention & control; D004334:Drug Administration Schedule; D005260:Female; D006442:Glycated Hemoglobin / Q000235:genetics / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; D007328:Insulin; C517652:hemoglobin A1c protein, human