Aging and Type 1 Diabetes: The “Big Picture” After 40 Years

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SAN DIEGO – The Landmark Diabetes Control Complications Trial (DCCT) follow-up has entered a new phase focused on the relatively recent phenomenon of aging in type 1 diabetes.

A new 2022-2027 funding for the DCCT long-term observational follow-up study Epidemiology of Diabetes Interventions and Complications (EDIC) will explore aspects of type 1 diabetes that are both associated with aging and common to type 2 diabetes. is devoted to Cardiovascular disease, fatty liver disease, sleep apnea syndrome, etc.

Results of the first randomized DCCT clinical trial, published on September 30, 1993, New England Journal of Medicine, have shown that early, intensive glycemic control is key to preventing or slowing the progression of long-term ocular, renal, and neurological complications in type 1 diabetes. Since then, EDIC has led to many more important discoveries, such as early tight glycemic control also reduces cardiovascular risk and prolongs survival in type 1 diabetes.

And while the metabolic memory phenomenon first seen with EDIC implies that early glycemic control is important, subsequent EDIC data indicate that it is too late to initiate intensive glycemic control. No, the speakers emphasized at a special symposium marking the 40th anniversary of glycemic control. His DCCT held during the recent American Diabetes Association 83rd Scientific Sessions. Similar to the DCCT/EDIC 30th Anniversary Symposium held in 2013, local research participants also joined the audience and were rewarded with long applause.

DCCT and EDIC, both funded by the National Institutes of Health at 27 sites in the United States and Canada, continue to change the standard of care for people with type 1 diabetes and inform clinical practice. Between 1930 and 1970, before DCCT, about one-third of people with type 1 diabetes developed vision loss, and one in five experienced renal failure or myocardial infarction. Strokes and amputations are also common, said DCCT/EDIC Chair David M. Nathan, M.D., Ph.D., when introducing the symposium.

“All advances in the treatment of type 1 diabetes have been made because this study has demonstrated the importance of continuous glucose monitoring (CGM), new insulins and better treatments. [insulin] Pumps… I think the most profound finding is that the intensively treated cohort has the same mortality rate as the general population.That says it all,” Nathan said. Medscape Medical News.

And now, “what we haven’t been able to contribute yet is what happens to type 1 diabetes as people age,” says Harvard Medical School professor and director of the Massachusetts General Hospital Diabetes Center in Boston. Mr Nathan added.

something no one could have ever imagined

The 1441 DCCT participants had a mean age of 27 years at baseline in 1983 when they were randomized to receive intensive insulin therapy or usual care. Of the 1375 participants (96%) who continued to participate in EDIC in 1994, mean age 35 at that time, the usual care group was taught intensive glycemic control, and all participants were assigned to a personal medical team. I’m back. The average age of his 1,075 currently participating in EDIC is he is 63 years old.

At the start of EDIC, only 11 participants had died, but as of this year, only 250 (17%) had died, said co-chair of the study coordinator and certified diabetes care education specialist (CDCES). ), RN’s Gail Lorenzi said. University of California San Diego.

“The longevity of DCCT/EDIC makes it a unique opportunity to explore long-term type 1 diabetes aging, something no one could have imagined before, especially for an audience that started their careers in the 70s and 80s. It’s an opportunity,” commented Lorenzi.

Currently, approximately 36% of the cohort are overweight and 40% are obese, reflecting the general population. And now their average A1c is 7.3%.

According to Dr. Barbara H. Brafett, Co-Principal Investigator of the DCCT/EDIC Data Coordination Center, “EDIC research is now focused over the next five years on understanding the clinical course of type 1 diabetes in its evolving setting.” It has a progressive effect on people with type 1 diabetes and can have long-term adverse effects. “

Brafett outlined new research approaches that will be added in 2022-2027. Cardiopulmonary exercise testing, 2D Doppler echocardiography, and carotid-femoral pulse wave velocity are used to quantify functional and structural changes central to heart failure.

Nathan said that by 2006 enough cardiovascular events were available in the EDIC, demonstrating a significant reduction of 58% in the intensive care group, but “now we can start investigating the aging heart. We have a lot of good cardiologists working with us, who guide us in measuring everything.”

Fatty liver disease in the setting of increasing obesity will also be investigated using transient elastography (FibroScan) and the FIB-4 Index, a quantification of liver enzymes and platelet counts.

Dr. Nathan said study participants “have had this kind of strange metabolic environment in the liver for decades. They don’t produce insulin in the pancreas, so the insulin they get is sent from the periphery to the liver.” Well, what does that do to them?”

Brafett said participants will also complete a three-symptom questionnaire to assess obstructive sleep apnea, which will guide future sleep research for patients found to be at high risk. It is an object.

Over 40 years of DCCT/EDIC: incredibly complete picture

By 2023, DCCT/EDIC participants will have been in study for over 60% of their lifespans and over 80% of their lives with diabetes, Brafett noted.

During the EDIC 2017-2022 cycle, Brafett and other speakers summarized that previous EDIC efforts have focused on aspects of cognitive function, physical function, and labioarthritis.

Other DCCT/EDIC studies have demonstrated the relationship between A1c and duration of diabetes in cardiovascular disease (CVD) risk, the association of microvascular complications beyond traditional risk factors with cardiovascular disease risk, and the first 30 DCCT The annual risk of severe hypoglycemia was investigated. /EDIC follow-up.

In addition, longitudinal ocular and renal evaluations over 40 years have informed screening guidelines for retinopathy and urinary albumin.

nathan said Medscape Medical News: “We have a very small number of patients today with dreaded complications, but we have not completely eliminated them…we have an incredibly complete picture of type 1 diabetes. , with which we can explore everything. We welcome people who come to us with ideas, and that is the value of this research.”

quoted by the speaker No related financial relationships were reported.

ADA Scientific Sessions. The symposium will be held on his June 25, 2023.

Miriam E. Tucker is a freelance journalist based in the Washington, DC area. She is a regular contributor to her Medscape, and her other work appears in The Washington Post, her Shots blog on NPR, and her Diabetes Forecast magazine. She’s on her Twitter: @MiriamETucker.

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