Continuation of Epidemiology of Diabetes Interventions and Complications (EDIC) Study Biostatistics Center

糖尿病干预和并发症流行病学 (EDIC) 研究继续生物统计中心

• 批准号: 9974506
• 负责人: Ionut Bebu
• 金额: $ 316.22万
• 依托单位: GEORGE WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-15 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9974506
• 关键词: Address; Adopted; Adverse effects; Affect; Affective; Age; Aging; American; Ancillary Study; Angiography; Architecture; Biological; Biometry; Blindness; Blood Glucose; Brain imaging; Cardiac; Cardiovascular Diseases; Cardiovascular system; Cessation of life; Chronic Kidney Failure; Cognition; Cognitive; Cognitive aging; Cohort Studies; Complications of Diabetes Mellitus; Cost Analysis; Data; Data Analyses; Development; Diabetes Mellitus; Diabetic Nephropathy; Disease; Economics; Epidemiology; Event; Eye; Factor Analysis; Follow-Up Studies; Fracture; Frequencies; Funding; General Population; Genotype; Glean; Glucose; Glycosylated hemoglobin A; Goals; Health; Health Care Costs; Health Insurance; Health Services Accessibility; Health system; Hyperglycemia; Hypoglycemia; Impaired cognition; Impairment; Individual; Insulin-Dependent Diabetes Mellitus; Intention; Intervention; Investments; Kidney Diseases; Kidney Failure; Life; Literature; Longevity; Longitudinal Studies; Measurement; Measures; Mediation; Memory; Metabolic; Metabolic Control; Microvascular Dysfunction; Modeling; Modernization; Morbidity - disease rate; Neurocognition; Neuropathy; Observational epidemiology; Operative Surgical Procedures; Outcome; Participant; Pathway interactions; Patients; Persons; Phenotype; Physical Function; Population; Prevalence; Procedures; Process; Quality of life; Randomized; Recommendation; Recording of previous events; Recurrence; Research; Resources; Retina; Retinal Diseases; Risk; Risk Factors; Sampling; Seminal; Testing; Well in self; adjudicate; blood glucose regulation; bone mass; bone quality; cardiovascular disorder risk; care outcomes; cohort; conventional therapy; cost effectiveness; diabetes control; diabetes mellitus therapy; disability; economic impact; falls; follow-up; frailty; functional status; health economics; healthy aging; kidney dysfunction; mortality; non-diabetic; novel; protective factors; screening; standard of care; tomography; treatment arm; treatment group; trial comparing; vector

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 yrs. Intensive therapy reduced the risks of retinopathy, nephropathy, and neuropathy by 35-76%, hyperglycemia being a primary determinant of complications. We also described potential 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. DCCT intensive therapy was then adopted world-wide as standard-of-care for T1DM. The Epidemiology of Diabetes Interventions and its Complications (EDIC, 1994-present) is the observational follow-up study of the DCCT cohort, with 94% of those surviving actively participating. Participants are evaluated annually. CVD events and deaths are carefully documented and adjudicated. EDIC has notably shown that the early beneficial effects of intensive versus conventional therapy on complications have persisted for more than 15 years despite the similar HbA1c levels in the two groups during EDIC, termed metabolic memory. Former intensive therapy also greatly reduced the risk of CVD events, advanced microvascular complications, such as chronic kidney disease and eye complications requiring surgery, and mortality. DCCT/EDIC collaborators have also conducted numerous ancillary studies with separate funding. The overarching goals for the next 5 years (2017-22) will be to take advantage of the loyal and highly characterized DCCT/EDIC cohort and study the occurrence of physical and cognitive dysfunction and more advanced complications, and their risk factors, in this aging type 1 diabetes population. Since current-day diabetes therapy has increased the longevity of people with type 1 diabetes, it is critical to understand how aging affects patients with type 1 diabetes and to define the risk factors for the occurrence of aging sensitive deficits. In addition, the accrual of long-term severe complications will allow the study of their risk factors and the quality-of-life and health economic consequences. The specific scientific aims are to 1) examine the prevalence of cognitive, affective, and physical impairments in T1DM, and the association of DCCT treatment arm, glycemia, and established and putative non-glycemic risk factors on important domains of aging: cognitive, affective and physical impairments, functional limitations, disability, quality-of-life, frailty, falls, fractures, and survival; 2) analyze the risk factors/mechanisms associated with severe/advanced microvascular complications; 3) analyze the risk factors/mechanisms associated with CVD and mortality; 4) develop new research approaches to measure the progression of diabetes outcomes (vectors) in T1DM, derived from the unique long-term, longitudinal follow-up of the DCCT cohort; and 5) study the long-term economic consequences of T1DM.

项目摘要 糖尿病控制与并发症试验（DCCT，1983- 1993年）比较了针对 在1441名受试者中，几乎正常血糖与常规疗法，没有特定的葡萄糖靶标 平均随访6.5年的糖尿病（T1DM）。强化疗法降低了视网膜病变的风险， 肾病和神经病占35-76％，高血糖是并发症的主要决定因素。我们 还描述了强化治疗的潜在不利影响；评估了其对心血管疾病的影响 （CVD）风险因素，神经认知和生活质量；并预测了终生的健康经济影响。 DCCT 然后，全世界将密集疗法作为T1DM的标准护理。 糖尿病干预及其并发症的流行病学（EDIC，1994年）是 DCCT队列的观察性随访研究，有94％的人积极参与。 每年对参与者进行评估。 CVD事件和死亡经过仔细的记录和裁决。 Edic 显然表明，密集型与常规疗法对并发症的早期有益作用 尽管在EDIC期间两组的HBA1C水平相似，但已持续了15年以上 代谢记忆。以前的强化疗法也大大降低了CVD事件的风险，高级 微血管并发症，例如慢性肾脏疾病和需要手术的眼睛并发症，以及 死亡。 DCCT/EDIC合作者还通过单独的资金进行了许多辅助研究。 未来5年的总体目标（2017-22）将是利用忠诚和高度的优势 表征了DCCT/EDIC队列并研究了物理和认知功能障碍的发生以及更多 在这种老化的1型糖尿病种群中，晚期并发症及其危险因素。自当天以来 糖尿病疗法提高了1型糖尿病患者的寿命，了解如何了解如何了解 衰老会影响1型糖尿病患者，并定义发生衰老敏感的危险因素 缺陷。此外，长期严重并发症的应计将允许研究其危险因素和 生活质量和健康经济后果。 具体的科学目的是1）检查认知，情感和身体的普遍性 T1DM的损伤以及DCCT治疗部门，血糖的关联以及建立和推定的 衰老重要领域的非血糖危险因素：认知，情感和身体障碍， 功能限制，残疾，生活质量，脆弱，跌倒，骨折和生存； 2）分析风险 与严重/晚期微血管并发症相关的因素/机制； 3）分析风险 与CVD和死亡率相关的因素/机制； 4）开发新的研究方法来衡量 T1DM中糖尿病结局（载体）的进展，源自独特的长期，纵向随访 DCCT队列； 5）研究T1DM的长期经济后果。