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What are the clinical, quality-of-life, and cost consequences of 30 years of excellent vs. poor glycemic control in type 1 diabetes?

William H Herman, Barbara H Braffett, Shihchen Kuo, Joyce M Lee, Michael Brändle, Alan M Jacobson, Lisa A Prosser & John M Lachin

abstract

OBJECTIVE
The Diabetes Control and Complications Trial (DCCT) demonstrated that intensive therapy for type 1 diabetes delayed the development of microvascular and neuropathic complications compared to conventional therapy. At the end of DCCT, all participants were trained in intensive therapy, care was transferred to community providers, and the difference in HbA1c between treatment groups narrowed and disappeared. Our objective was to describe the outcomes and the quality-of-life and costs associated with those outcomes in participants who maintained excellent vs. poor glycemic control over 30 years.

RESEARCH DESIGN AND METHODS
We assessed the incidence of retinopathy, nephropathy, neuropathy, cardiovascular disease, acute metabolic complications, death, quality-of-life, and costs in the tertile of DCCT intensive therapy participants who achieved a mean updated HbA1c of <7.2% (55 mmol/mol) and the tertile of DCCT conventional therapy participants (n = 240) who achieved a mean updated HbA1c of >8.8% (73 mmol/mol) over 30 years.

RESULTS
Thirty years of excellent vs. poor glycemic control substantially reduced the incidence of retinopathy requiring laser therapy (5% vs. 45%), end-stage renal disease (0% vs. 5%), clinical neuropathy (15% vs. 50%), myocardial infarction (3% vs. 5%), stroke (0.4% vs. 2%), and death (6% vs. 20%). It also resulted in a gain of ~1.62 quality-adjusted life-years and averted ~$90,900 in costs of complications per participant.

CONCLUSIONS
Thirty years of excellent vs. poor glycemic control for T1DM can substantially reduce the incidence of complications, comorbidities, and death, improve quality-of-life, and reduce costs. These estimates represent the benefits that may be achieved with excellent glycemic control.
   
citation Herman W H, Braffett B H, Kuo S, Lee J M, Brändle M, Jacobson A M, Prosser L A, Lachin J M. What are the clinical, quality-of-life, and cost consequences of 30 years of excellent vs. poor glycemic control in type 1 diabetes?. J Diabetes Complicat 2018; 32:911-915.
   
type journal paper/review (English)
date of publishing 12-06-2018
journal title J Diabetes Complicat (32/10)
ISSN electronic 1873-460X
pages 911-915
PubMed 30082172
DOI 10.1016/j.jdiacomp.2018.05.007