Relationships Between the Cumulative Incidences of Long-term Complications in Type 1 Diabetes: The DCCT/EDIC Study
Authors' conclusion
Long-term micro- and macrovascular complications and mortality are highly correlated. Age, diabetes duration, and glycemic levels do not completely explain these associations.
Study context
- Population
- Individuals with T1D in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study
- Exposure
- Cumulative incidence of each complication with vs without a prior other complication
- Outcome
- Cumulative incidences of PDR, CSME, reduced eGFR, amputations, CVD and mortality, and their associations independent of age, duration of diabetes and glycemic levels
- Follow-up
- ∼30 years
Methodological detailslong-term follow-up of the DCCT/EDIC study, ≈30 years follow-up
- Long-term follow-up of the DCCT/EDIC study
- ≈30 years follow-up
Main finding
As reported in the abstract
Associations between complications, adjusted for age, duration of T1D and mean updated HbA1c
- Cumulative incidence of complications, range (amputations to clinically significant macular edema (CSME))
- 3% to 37%
- Proliferative diabetic retinopathy (PDR) with higher risk of CSME
- HR 1.88; 95% CI 1.42, 2.50
- PDR with higher risk of reduced estimated glomerular filtration rate (eGFR)
- HR 1.41; 95% CI 1.01, 1.97
- PDR with higher risk of cardiovascular disease (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
- CSME with higher risk of reduced eGFR
- HR 1.49; 95% CI 1.10, 2.01
- CSME with higher risk of 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
- Reduced eGFR with higher risk of death
- HR 3.40; 95% CI 2.35, 4.92
- Amputation(s) with death (estimate outside its printed CI, as printed)
- HR 2.97; 95% CI 1.70, 2.90
- CVD with higher risk of reduced eGFR
- HR 1.59; 95% CI 1.08, 2.34
- CVD with higher risk of death
- HR 1.95; 95% CI 1.32, 2.90
Observational data: associations, not effects.
Further findings
Cumulative incidence of PDR, with vs without prior complication
- Prior CSME vs none
- 66% vs. 15%
- Prior reduced eGFR vs none
- 59% vs. 29%
- Prior amputation vs none
- 68% vs. 32%
Cumulative incidence of reduced eGFR, with vs without prior complication
- Prior PDR vs none
- 25% vs. 9%
- Prior amputation vs none
- 48% vs. 13%
- Prior CVD vs none
- 30% vs. 11%
Cumulative incidence of CVD, with vs without prior complication
- Prior reduced eGFR vs none
- 37% vs. 14%
- Prior amputation vs none
- 50% vs. 16%
Cumulative incidence of mortality, with vs without prior complication
- Prior reduced eGFR vs none
- 22% vs. 9%
- Prior amputation vs none
- 35% vs. 8%
- Prior CVD vs none
- 25% vs. 8%
Original publication
Relationships Between the Cumulative Incidences of Long-term Complications in Type 1 Diabetes: The DCCT/EDIC Study. Diabetes Care. Published 15 December 2022. doi:10.
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