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)比较了针对接近正常的强化治疗 1441例1型糖尿病(T1 DM)以上患者的血糖与无特异性血糖指标的常规治疗的比较 平均随访时间为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%。 血糖水平是并发症的主要决定因素。我们还描述了密集的不良影响 治疗；评估其对心血管疾病风险因素、神经认知和生活质量的影响；以及 终生健康--经济影响。在1993年报告了初步的DCCT结果后，强化治疗旨在 HbA1c&lt；7%在世界范围内被采纳为T1 DM的标准护理。 《糖尿病干预和并发症的流行病学》(EDIC，1994-至今)是一项观察性随访 DCCT队列的研究。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进行了测量，并仔细记录和 裁决的事件。EDIC已经显著地表明，强化治疗与常规治疗相比，对 尽管在EDIC期间两组患者的HbA1c水平趋于一致，但并发症仍持续了约15年 概念称为新陈代谢记忆。先前的强化治疗也被证明显著降低了心血管事件的风险。 和死亡率。 未来5年(2022-27年)的总体目标将是研究发生的情况并确定潜在的可修改 较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 这是随着糖尿病病程和年龄的增加而发生的。随着寿命的延长，肥胖的增加 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、衰老和肥胖对发病率及其潜在危险因素的影响。这一结果将指导治疗 随着T1 DM患者年龄的增长，优先考虑。 2022年至2027年的具体目标是：1)确定晚期微血管并发症的发生率， 调查它们的发育顺序和共同发育的模式，并确定血糖和非血糖风险 2)量化预示心力衰竭(HF)的功能和心肌功能损害，并确定 T1 DM损害的危险因素；3)确定非酒精性脂肪肝(NAFLD)的患病率和 脂肪性肝炎相关纤维化(NASH)和提示阻塞性睡眠呼吸暂停(OSA)的症状 超重/肥胖的T1糖尿病研究人群并确定先期风险因素和机制；以及4)继续 对衰老敏感疾病的纵向评估，如认知和身体功能障碍、虚弱及其风险 影响生活质量、自我管理1型糖尿病的能力和健康经济结果的因素及其综合影响。

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.