Epidemiology of Diabetes Interventions and Complications (EDIC) Study

糖尿病干预和并发症 (EDIC) 流行病学研究

• 批准号: 10532512
• 负责人: Ionut Bebu
• 金额: $ 650万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-22 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10532512
• 关键词: Activities of Daily Living; Address; Adopted; Advanced Development; Adverse effects; Affect; Age; Aging; American; Amputation; Anatomy; Angiography; Attention; Autonomic Dysfunction; Biological Markers; Blindness; Blood Vessels; Canada; Cardiac; Cardiopulmonary; Cardiovascular Diseases; Cardiovascular system; Caring; Clinical; Clinical Treatment; Clinical Trials; Cognitive; Cohort Studies; Community Trial; Complications of Diabetes Mellitus; Development; Diabetes Mellitus; Disease Outcome; Echocardiography; Epidemiology; Epigenetic Process; Esthesia; Event; Exercise; Exercise Test; Exposure to; Eye; Fibrosis; Follow-Up Studies; Functional Imaging; Functional disorder; Funding; Generations; Genetic; Glucose; Glycosylated hemoglobin A; Goals; Health Care Costs; Heart Diseases; Heart failure; Heterogeneity; Hyperglycemia; Impaired cognition; Impairment; Incidence; Individual; Inflammation; Insulin-Dependent Diabetes Mellitus; Intervention; Kidney; Kidney Diseases; Kidney Failure; Kinetics; Knowledge; Lead; Liver; Liver diseases; Longevity; Longitudinal cohort study; Lung; Measurement; Measures; Mediation; Memory; Metabolic; Methods; Microvascular Dysfunction; Morbidity - disease rate; Myocardial; Nerve; Neurocognition; Neuropathy; Non-Insulin-Dependent Diabetes Mellitus; North America; Obesity; Observational Study; Obstructive Sleep Apnea; Optical Coherence Tomography; Organ; Outcome; Overweight; Oxygen; Participant; Pathway interactions; Patients; Pattern; Performance; Phenotype; Physical Function; Population; Prevalence; Quality of life; Questionnaires; Randomized; Recording of previous events; Reporting; Resistance; Retina; Retinal Diseases; Risk; Risk Factors; Self Management; Severity of illness; Sleep Apnea Syndromes; Standardization; Steatohepatitis; Stress; Subgroup; Suggestion; Symptoms; Time; Ulcer; Vital Status; Weight Gain; adjudicate; adverse outcome; arterial stiffness; base; cardiovascular disorder risk; cognitive function; cohort; community based care; comorbidity; conventional therapy; cost; diabetes control; diabetes management; economic impact; economic outcome; effective intervention; exercise intolerance; experience; fatty liver disease; fitness; follow-up; frailty; health assessment; health economics; high risk; improved; indexing; innovation; lens; liver stiffness; macrovascular disease; modifiable risk; mortality; non-alcoholic fatty liver disease; non-diabetic; novel; obese person; painful neuropathy; public health priorities; response; skeletal; sleep abnormalities; standard of care; study population; tonometry; trial comparing; uptake

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.

项目摘要 糖尿病控制与并发症试验（DCCT，1983- 1993年）比较了针对近期正常的强化疗法 在1441名患有1型糖尿病（T1DM）的受试者中，血糖与常规疗法没有特定的葡萄糖靶标 平均随访6。5年。强化疗法将视网膜病变，肾病和神经病的风险降低了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利影响 治疗;评估了其对心血管疾病（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年报告了主要的DCCT结果后，旨在 HbA1c <7％在全球范围内被用作T1DM的标准护理。 糖尿病干预措施和并发症的流行病学（EDIC，1994年至今）是观察性随访 DCCT队列的研究。微型和心血管并发症以及广泛的既定风险 通过仔细记录的标准化方法测量了包括遗传和表观遗传因素在内的因素， 事件裁定。 EDIC显然表明，密集型与常规疗法的早期有益作用对 尽管在EDIC期间两组中HBA1C水平融合，并发症仍持续约15年。 概念称为代谢记忆。还显示先前的强化疗法大大降低了CVD事件的风险 和死亡率。 未来5年（2022-27）的总体目标将是研究发生并确定潜在的可修改 更先进的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 随着糖尿病持续时间和年龄的增加而发生的。随着寿命的增加，肥胖的增加 受影响的T1DM患者（包括EDIC参与者）有潜在的不利后果。因此，糖尿病的影响 将研究持续时间，衰老和肥胖性及其潜在危险因素。结果将指导治疗 优先考虑T1DM患者的年龄。 2022-2027的具体目的是：1）确定晚期微血管并发症的发生率， 研究其发展的顺序和共同开发的模式，并确定血糖和非血糖风险 因素； 2）量化预示心力衰竭（HF）的功能和心肌性能的损伤并确定 T1DM损伤的危险因素； 3）确定非酒精性脂肪肝病（NAFLD）和 脂肪性肝炎相关的纤维化（NASH）和暗示阻塞性睡眠呼吸暂停（OSA）的症状越来越多地 超重/肥胖的T1DM研究人群并确定先例的风险因素和机制； 4）继续 纵向评估对衰老敏感的病毒性，例如认知和身体功能障碍，脆弱及其风险 因素及其对生活质量，自我管理T1DM的能力以及健康经济成果的总体影响。