Association of Glycemic Control With Reduced Risk for Large-Vessel Disease After More Than 50 Years of Type 1 Diabetes

Abstract

Few large populations with long duration of (T1D) have been available to examine the effects of long-term exposure to hyperglycemia. These data indicate that an association of glycemic control, complications, and mortality may change in an older population with T1D. These results suggest that careful control is still warranted in older populations with T1D.

Differential Association of Microvascular Attributions With Cardiovascular Disease in Patients With Long Duration of Type 1 Diabetes

“…However, definitions for vascular complications were equally defined, and the marginal dissimilarity in the cutoff for PDR (ETDRS 53 vs. 60) was considered not relevant. Finally, the results did not change after adjustment for exercise, shown to be strongly associated with CVD in the Medalists (13).…”

“…All individuals had documented at least 50 years of insulin treatment for type 1 diabetes and were examined at the Joslin Diabetes Center. Only patients with comprehensive data on micro-and macrovascular complications (n = 762) were included in the analysis (13). Participants completed medical history questionnaires and received a physical and an ophthalmic examination at the Joslin Diabetes Center.…”

Cognitive Function Deficits Associated With Long-Duration Type 1 Diabetes and Vascular Complications

“…Importantly, an advantage of the diabetes duration among Medalists is that it is long enough to evaluate the association of complications on the brain in a way that is not possible in younger cohorts, as complications have likely fully manifested after 50 years of disease duration. This is critical as not only the incidence of type 1 diabetes increases but also as increasing longevity with the disease has now been documented by several groups (32)(33)(34). This line of research allows us to contrast the ways in which glycemic dysregulation in type 1 diabetes is linked to cognitive dysfunction compared with type 2 diabetes.…”

Risk factors for diabetic kidney disease in adults with longstanding type 1 diabetes: results from the Canadian Study of Longevity in Diabetes

“…Optimal metabolic control is critical for avoiding short and long-term complications in the setting of T1D, including maintenance of normoglycemia with basal and prandial insulin management. For example, in the Diabetes Control and Complications Trial, intensive glycemic control was associated with a reduction in the risk of developing diabetic kidney disease (DKD), which is detected through routine monitoring of albumin excretion and estimated glomerular filtration rate (eGFR) annually [7][8][9]. Observational studies also support the link between glycemic control and microvascular complications, including DKD in T1D [10][11][12][13].…”