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

DCCT/EDIC Research Group

doi:10.2337/dc20-0226

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

DCCT/EDIC Research Group

Medicine, Endocrinology Division

Research output: Contribution to journal › Article › peer-review

18 Scopus citations

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 HbA_1c (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 HbA_1c. RESULTS The risk of any cardiovascular disease associated with a 1-percentage point increase in HbA_1c 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 HbA_1c 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 HbA_1c 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.

Original language	English (US)
Pages (from-to)	2478-2484
Number of pages	7
Journal	Diabetes care
Volume	43
Issue number	10
DOIs	https://doi.org/10.2337/dc20-0226
State	Published - Oct 2020

Funding

Funding. The DCCT/EDIC has been supported by cooperative agreement grants (1982–1993, 2012–2017, and 2017–2022) and contracts (1982–2012) with the Division of Diabetes, Endocrinology, and Metabolic Diseases of the National Institute of Diabetes and Digestive and Kidney Diseases (grants U01 DK094176 and U01 DK094157) and through support by the National Eye Institute, the National Institute of Neurological Disorders and Stroke, the General Clinical Research Center Program (1993–2007), and Clinical and Translational Science Center Program (2006–present) (Bethesda, MD). Industry contributors have had no role in the DCCT/EDIC study but have provided free or discounted supplies or equipment to support participants’ adherence to the study: Abbott Diabetes Care (Alameda, CA), Animas Corporation (West Chester, PA), Bayer Diabetes Care (Tarrytown, NY), Becton Dickinson (Franklin Lakes, NJ), Eli Lilly and Company (Indianapolis, IN), Extend Nutrition (St. Louis, MO), Insulet Corporation (Bedford, MA), LifeScan, Inc. (Mil-pitas, CA), Medtronic Diabetes (Minneapolis, MN), Nipro Home Diagnostics, Inc. (Fort Lauderdale, FL), Nova Diabetes Care (Billerica, MA), Omron (Shelton, CT), Perrigo Diabetes Care (Allegan, MI), Roche Diabetes Care (Indianapolis, IN), and Sanofi U.S. (Bridgewater, NJ). Duality of Interest. No potential conflicts of interest relevant to this article were reported. Author Contributions. I.B. wrote the initial draft of the manuscript with assistance from J.M.L. and conducted all analyses. B.H.B., D.S., W.S., J.I.M., R.P.-B., G.M.L., P.L., V.R.T., A.W., and W.H.H. contributed to the specification of the analyses and critically reviewed and edited the manuscript. I.B. is the guarantor of this work and, as such, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The DCCT/EDIC has been supported by cooperative agreement grants (1982–1993, 2012–2017, and 2017–2022) and contracts (1982–2012) with the Division of Diabetes, Endocrinology, and Metabolic Diseases of the National Institute of Diabetes and Digestive and Kidney Diseases (grants U01 DK094176 and U01 DK094157) and through support by the National Eye Institute, the National Institute of Neurological Disorders and Stroke, the General Clinical Research Center Program (1993–2007), and Clinical and Translational Science Center Program (2006–present) (Bethesda, MD). Industry contributors have had no role in the DCCT/EDIC study but have provided free or discounted supplies or equipment to support participants’ adherence to the study: Abbott Diabetes Care (Alameda, CA), Animas Corporation (West Chester, PA), Bayer Diabetes Care (Tarrytown, NY), Becton Dickinson (Franklin Lakes, NJ), Eli Lilly and Company (Indianapolis, IN), Extend Nutrition (St. Louis, MO), Insulet Corporation (Bedford, MA), LifeScan, Inc. (Milpitas, CA), Medtronic Diabetes (Minneapolis, MN), Nipro Home Diagnostics, Inc. (Fort Lauderdale, FL), Nova Diabetes Care (Billerica, MA), Omron (Shelton, CT), Perrigo Diabetes Care (Allegan, MI), Roche Diabetes Care (Indianapolis,IN),andSanofi U.S. (Bridgewater, NJ). Duality of Interest. No potential conflicts of interest relevant to this article were reported. Author Contributions. I.B. wrote the initial draft of the manuscript with assistance from J.M.L. and conducted all analyses. B.H.B., D.S., W.S., J.I.M., R.P.-B., G.M.L., P.L., V.R.T., A.W., and W.H.H. contributed to the specification of the analyses and critically reviewed and edited the manuscript. I.B. is the guarantor of this work and, as such, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

ASJC Scopus subject areas

Advanced and Specialized Nursing
Internal Medicine
Endocrinology, Diabetes and Metabolism

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.2337/dc20-0226

Cite this

@article{6ad2169fefad4e0db1254dcb6b6ce370,

title = "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",

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{\textquoteright} 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{\textquoteright} 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{\textquoteright} 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.",

author = "{DCCT/EDIC Research Group} and Ionut Bebu and Braffett, {Barbara H.} and David Schade and William Sivitz and Malone, {John I.} and Rodica Pop-Busui and Lorenzi, {Gayle M.} and Pearl Lee and Trapani, {Victoria R.} and Amisha Wallia and Herman, {William H.} and Lachin, {John M.}",

note = "Funding Information: Funding. The DCCT/EDIC has been supported by cooperative agreement grants (1982–1993, 2012–2017, and 2017–2022) and contracts (1982–2012) with the Division of Diabetes, Endocrinology, and Metabolic Diseases of the National Institute of Diabetes and Digestive and Kidney Diseases (grants U01 DK094176 and U01 DK094157) and through support by the National Eye Institute, the National Institute of Neurological Disorders and Stroke, the General Clinical Research Center Program (1993–2007), and Clinical and Translational Science Center Program (2006–present) (Bethesda, MD). Industry contributors have had no role in the DCCT/EDIC study but have provided free or discounted supplies or equipment to support participants{\textquoteright} adherence to the study: Abbott Diabetes Care (Alameda, CA), Animas Corporation (West Chester, PA), Bayer Diabetes Care (Tarrytown, NY), Becton Dickinson (Franklin Lakes, NJ), Eli Lilly and Company (Indianapolis, IN), Extend Nutrition (St. Louis, MO), Insulet Corporation (Bedford, MA), LifeScan, Inc. (Mil-pitas, CA), Medtronic Diabetes (Minneapolis, MN), Nipro Home Diagnostics, Inc. (Fort Lauderdale, FL), Nova Diabetes Care (Billerica, MA), Omron (Shelton, CT), Perrigo Diabetes Care (Allegan, MI), Roche Diabetes Care (Indianapolis, IN), and Sanofi U.S. (Bridgewater, NJ). Duality of Interest. No potential conflicts of interest relevant to this article were reported. Author Contributions. I.B. wrote the initial draft of the manuscript with assistance from J.M.L. and conducted all analyses. B.H.B., D.S., W.S., J.I.M., R.P.-B., G.M.L., P.L., V.R.T., A.W., and W.H.H. contributed to the specification of the analyses and critically reviewed and edited the manuscript. I.B. is the guarantor of this work and, as such, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Funding Information: The DCCT/EDIC has been supported by cooperative agreement grants (1982–1993, 2012–2017, and 2017–2022) and contracts (1982–2012) with the Division of Diabetes, Endocrinology, and Metabolic Diseases of the National Institute of Diabetes and Digestive and Kidney Diseases (grants U01 DK094176 and U01 DK094157) and through support by the National Eye Institute, the National Institute of Neurological Disorders and Stroke, the General Clinical Research Center Program (1993–2007), and Clinical and Translational Science Center Program (2006–present) (Bethesda, MD). Industry contributors have had no role in the DCCT/EDIC study but have provided free or discounted supplies or equipment to support participants{\textquoteright} adherence to the study: Abbott Diabetes Care (Alameda, CA), Animas Corporation (West Chester, PA), Bayer Diabetes Care (Tarrytown, NY), Becton Dickinson (Franklin Lakes, NJ), Eli Lilly and Company (Indianapolis, IN), Extend Nutrition (St. Louis, MO), Insulet Corporation (Bedford, MA), LifeScan, Inc. (Milpitas, CA), Medtronic Diabetes (Minneapolis, MN), Nipro Home Diagnostics, Inc. (Fort Lauderdale, FL), Nova Diabetes Care (Billerica, MA), Omron (Shelton, CT), Perrigo Diabetes Care (Allegan, MI), Roche Diabetes Care (Indianapolis,IN),andSanofi U.S. (Bridgewater, NJ). Duality of Interest. No potential conflicts of interest relevant to this article were reported. Author Contributions. I.B. wrote the initial draft of the manuscript with assistance from J.M.L. and conducted all analyses. B.H.B., D.S., W.S., J.I.M., R.P.-B., G.M.L., P.L., V.R.T., A.W., and W.H.H. contributed to the specification of the analyses and critically reviewed and edited the manuscript. I.B. is the guarantor of this work and, as such, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Publisher Copyright: {\textcopyright} 2020 by the American Diabetes Association.",

year = "2020",

month = oct,

doi = "10.2337/dc20-0226",

language = "English (US)",

volume = "43",

pages = "2478--2484",

journal = "Diabetes care",

issn = "0149-5992",

publisher = "American Diabetes Association Inc.",

number = "10",

}

TY - JOUR

T1 - 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

AU - DCCT/EDIC Research Group

AU - Bebu, Ionut

AU - Braffett, Barbara H.

AU - Schade, David

AU - Sivitz, William

AU - Malone, John I.

AU - Pop-Busui, Rodica

AU - Lorenzi, Gayle M.

AU - Lee, Pearl

AU - Trapani, Victoria R.

AU - Wallia, Amisha

AU - Herman, William H.

AU - Lachin, John M.

N1 - Funding Information: Funding. The DCCT/EDIC has been supported by cooperative agreement grants (1982–1993, 2012–2017, and 2017–2022) and contracts (1982–2012) with the Division of Diabetes, Endocrinology, and Metabolic Diseases of the National Institute of Diabetes and Digestive and Kidney Diseases (grants U01 DK094176 and U01 DK094157) and through support by the National Eye Institute, the National Institute of Neurological Disorders and Stroke, the General Clinical Research Center Program (1993–2007), and Clinical and Translational Science Center Program (2006–present) (Bethesda, MD). Industry contributors have had no role in the DCCT/EDIC study but have provided free or discounted supplies or equipment to support participants’ adherence to the study: Abbott Diabetes Care (Alameda, CA), Animas Corporation (West Chester, PA), Bayer Diabetes Care (Tarrytown, NY), Becton Dickinson (Franklin Lakes, NJ), Eli Lilly and Company (Indianapolis, IN), Extend Nutrition (St. Louis, MO), Insulet Corporation (Bedford, MA), LifeScan, Inc. (Mil-pitas, CA), Medtronic Diabetes (Minneapolis, MN), Nipro Home Diagnostics, Inc. (Fort Lauderdale, FL), Nova Diabetes Care (Billerica, MA), Omron (Shelton, CT), Perrigo Diabetes Care (Allegan, MI), Roche Diabetes Care (Indianapolis, IN), and Sanofi U.S. (Bridgewater, NJ). Duality of Interest. No potential conflicts of interest relevant to this article were reported. Author Contributions. I.B. wrote the initial draft of the manuscript with assistance from J.M.L. and conducted all analyses. B.H.B., D.S., W.S., J.I.M., R.P.-B., G.M.L., P.L., V.R.T., A.W., and W.H.H. contributed to the specification of the analyses and critically reviewed and edited the manuscript. I.B. is the guarantor of this work and, as such, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Funding Information: The DCCT/EDIC has been supported by cooperative agreement grants (1982–1993, 2012–2017, and 2017–2022) and contracts (1982–2012) with the Division of Diabetes, Endocrinology, and Metabolic Diseases of the National Institute of Diabetes and Digestive and Kidney Diseases (grants U01 DK094176 and U01 DK094157) and through support by the National Eye Institute, the National Institute of Neurological Disorders and Stroke, the General Clinical Research Center Program (1993–2007), and Clinical and Translational Science Center Program (2006–present) (Bethesda, MD). Industry contributors have had no role in the DCCT/EDIC study but have provided free or discounted supplies or equipment to support participants’ adherence to the study: Abbott Diabetes Care (Alameda, CA), Animas Corporation (West Chester, PA), Bayer Diabetes Care (Tarrytown, NY), Becton Dickinson (Franklin Lakes, NJ), Eli Lilly and Company (Indianapolis, IN), Extend Nutrition (St. Louis, MO), Insulet Corporation (Bedford, MA), LifeScan, Inc. (Milpitas, CA), Medtronic Diabetes (Minneapolis, MN), Nipro Home Diagnostics, Inc. (Fort Lauderdale, FL), Nova Diabetes Care (Billerica, MA), Omron (Shelton, CT), Perrigo Diabetes Care (Allegan, MI), Roche Diabetes Care (Indianapolis,IN),andSanofi U.S. (Bridgewater, NJ). Duality of Interest. No potential conflicts of interest relevant to this article were reported. Author Contributions. I.B. wrote the initial draft of the manuscript with assistance from J.M.L. and conducted all analyses. B.H.B., D.S., W.S., J.I.M., R.P.-B., G.M.L., P.L., V.R.T., A.W., and W.H.H. contributed to the specification of the analyses and critically reviewed and edited the manuscript. I.B. is the guarantor of this work and, as such, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Publisher Copyright: © 2020 by the American Diabetes Association.

PY - 2020/10

Y1 - 2020/10

N2 - 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.

AB - 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.

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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

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