Epidemiology of Diabetes Interventions and Complications (EDIC) Study

项目摘要 糖尿病控制和并发症试验（DCCT，1983-1993）比较了旨在接近正常的强化治疗 在1441例1型糖尿病（T1 DM）受试者中比较无特定血糖目标的常规治疗与无特定血糖目标的常规治疗， 平均随访6.5年。强化治疗可将视网膜病变、肾病和神经病变的风险降低35- 76%。 手术并发症的主要决定因素是手术平面。我们还描述了密集的不利影响， 治疗;评估其对心血管疾病（CVD）危险因素，神经认知和生活质量的影响;并预测 终身健康经济影响。在1993年报道了DCCT的初步结果后， HbA 1c <7%在全球范围内被采纳为T1 DM的标准治疗。 糖尿病干预和并发症的流行病学（EDIC，1994年至今）是观察性随访 DCCT队列研究。微血管和心血管并发症以及广泛的既定和推定风险 因素，包括遗传和表观遗传因素，已经用标准化的方法测量，仔细记录， 裁定的事件。EDIC已经明显表明，强化治疗与常规治疗相比， 尽管EDIC期间两组的HbA 1c水平一致，但并发症持续了约15年， 代谢记忆的概念。先前的强化治疗也被证明可以大大降低CVD事件的风险 and mortality. 未来5年（2022- 2027年）的总体目标是研究发生率并确定潜在的可修改性 更晚期微血管和心血管并发症以及身体和认知功能障碍的危险因素 随着糖尿病病程和年龄的增加而发生。随着寿命的延长， 受影响的T1 DM患者，包括EDIC参与者，具有潜在的不良后果。因此，糖尿病的影响 将研究病程、年龄和肥胖对发病率及其潜在危险因素的影响。结果将指导治疗 随着T1 DM患者年龄的增长， 2022-2027年的具体目标是：1）确定晚期微血管并发症的发生率， 调查其发展顺序和共同发展模式，并识别血糖和非血糖风险 因素; 2）量化预示心力衰竭（HF）的功能和心肌性能损伤，并确定 T1 DM损害的风险因素; 3）确定非酒精性脂肪性肝病（NAFLD）的患病率， 脂肪性肝炎相关性纤维化（NASH）和提示阻塞性睡眠呼吸暂停（OSA）的症状， 超重/肥胖T1 DM研究人群，并确定既往风险因素和机制;以及4）继续 对年龄敏感性疾病的纵向评估，如认知和身体功能障碍、虚弱及其风险 因素及其对生活质量、T1 DM自我管理能力和健康经济结局的总体影响。

Project Summary The Diabetes Control and Complications Trial (DCCT,1983-1993) compared intensive therapy aimed at near-normal glycemia versus conventional therapy with no specific glucose targets in 1441 subjects with type 1 diabetes (T1DM) over a mean follow-up of 6.5 years. Intensive therapy reduced the risks of retinopathy, nephropathy, and neuropathy by 35-76%. The level of glycemia was the primary determinant of complications. We also described the adverse effects of intensive therapy; assessed its effects on cardiovascular disease (CVD) risk factors, neurocognition and quality of life; and projected the lifetime health-economic impact. After the primary DCCT results were reported in 1993, intensive therapy aiming for a HbA1c <7% was adopted world-wide as standard-of-care for T1DM. The Epidemiology of Diabetes Interventions and Complications (EDIC, 1994-present) is the observational follow-up study of the DCCT cohort. Micro- and cardio-vascular complications and a wide range of established and putative risk factors, including genetic and epigenetic factors, have been measured with standardized methods, carefully documented and events adjudicated. EDIC has notably shown that the early beneficial effects of intensive versus conventional therapy on complications persisted for ~15 years despite the convergence of HbA1c levels in the two groups during EDIC, a novel concept termed metabolic memory. Prior intensive therapy was also shown to reduce substantially the risk of CVD events and mortality. The overarching goals for the next 5 years (2022-27) will be to study the occurrence and identify potentially modifiable risk factors of the more advanced microvascular and cardiovascular complications and physical and cognitive dysfunction that are occurring with increasing diabetes duration and age. With increasing longevity, the increased adiposity that has affected patients with T1DM, including EDIC participants, has potential adverse consequences. Thus, the impact of diabetes duration, aging and adiposity on morbidities and their underlying risk factors will be studied. The results will guide treatment priorities as T1DM patients age. The specific aims for 2022-2027 are to: 1) determine the incidence of advanced microvascular complications, investigate the order of their development and pattern of co-development, and identify glycemic and non-glycemic risk factors; 2) quantify impairment in functional and myocardial performance that presages heart failure (HF) and identify the risk factors for impairment in T1DM; 3) determine the prevalence of Non-Alcoholic Fatty Liver Disease (NAFLD) and steatohepatitis-associated fibrosis (NASH) and symptoms suggestive of obstructive sleep apnea (OSA) in this increasingly overweight/obese T1DM study population and identify precedent risk factors and mechanisms; and 4) continue the longitudinal assessment of aging-sensitive morbidities such as cognitive and physical dysfunction, frailty, and their risk factors and their aggregate impact on quality of life, ability to self-manage T1DM, and health economic outcomes.