@article {1661825,
	title = {Relationships Between the Cumulative Incidences of Long-term Complications in Type 1 Diabetes: the DCCT/EDIC Study},
	journal = {Diabetes Care},
	year = {2022},
	month = {2022 Dec 15},
	abstract = {OBJECTIVE: To describe the relationships between the cumulative incidences of long-term complications in individuals with type 1 diabetes (T1D) and assess whether observed associations are independent of age, duration of diabetes, and glycemic levels. METHODS: Proliferative diabetic retinopathy (PDR), clinically significant macular edema (CSME), reduced estimated glomerular filtration rate (eGFR), amputations, cardiovascular disease (CVD), and mortality were assessed in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study over \~{}30 years. RESEARCH DESIGN AND RESULTS: The cumulative incidence of complications ranged from 3\% (amputations) to 37\% (CSME). There were large differences in the cumulative incidence of PDR between participants with versus without prior CSME (66\% vs. 15\%), reduced eGFR (59\% vs. 29\%), and amputation (68\% vs. 32\%); reduced eGFR with or without prior PDR (25\% vs. 9\%), amputation (48\% vs. 13\%), and CVD (30\% vs. 11\%); CVD with or without prior reduced eGFR (37\% vs. 14\%) and amputation (50\% vs. 16\%); and mortality with or without prior reduced eGFR (22\% vs. 9\%), amputation (35\% vs. 8\%), and CVD (25\% vs. 8\%). Adjusted for age, duration of T1D, and mean updated HbA1c, the complications and associations with higher risk included PDR with CSME (hazard ratio [HR] 1.88; 95\% CI 1.42, 2.50), reduced eGFR (HR 1.41; 95\% CI 1.01, 1.97), and CVD (HR 1.43; 95\% CI 1.06, 1.92); CSME with higher risk of PDR (HR 3.94; 95\% CI 3.18 4.89), reduced eGFR (HR 1.49; 95\% CI 1.10, 2.01), and CVD (HR 1.35; 95\% CI 1.03, 1.78); reduced eGFR with higher risk of CVD (HR 2.09; 95\% CI 1.44, 3.03), and death (HR 3.40; 95\% CI 2.35, 4.92); amputation(s) with death (HR 2.97; 95\% CI 1.70, 2.90); and CVD with reduced eGFR (HR 1.59; 95\% CI 1.08, 2.34) and death (HR 1.95; 95\% CI 1.32, 2.90). CONCLUSIONS: Long-term micro- and macrovascular complications and mortality are highly correlated. Age, diabetes duration, and glycemic levels do not completely explain these associations.},
	issn = {1935-5548},
	doi = {10.2337/dc22-1744},
	author = {Bebu, Ionut and Braffett, Barbara H and de Boer, Ian H and Aiello, Lloyd P and Bantle, John P and Lorenzi, Gayle M and Herman, William H and Gubitosi-Klug, Rose A and Perkins, Bruce A and Lachin, John M and Molitch, Mark E and DCCT/EDIC Research Group}
}
