Association between 7 years of intensive treatment of type 1 XXXX and long-term mortality.

@entity1 @entity101 @entity6 @entity5 @entity4053 @entity633 @entity2412 @entity204 @entity4854 @entity65
IMPORTANCE: Whether mortality in @entity6 is affected following intensive glycemic therapy has not been established. OBJECTIVE: To determine whether mortality differed between the original intensive and conventional treatment groups in the long-term follow-up of the @entity6 Control and Complications Trial (DCCT) cohort. DESIGN, SETTING, AND @entity1 : After the DCCT (1983-1993) ended, @entity1 were followed up in a multisite (27 US and Canadian academic clinical centers) observational study (Epidemiology of @entity6 Control and Complications [EDIC]) until December 31, 2012. @entity1 were 1441 healthy volunteers with @entity6 who, at baseline, were 13 to 39 years of age with 1 to 15 years of @entity6 duration and no or early microvascular complications, and without @entity101 , preexisting @entity65 , or other potentially life-threatening disease. INTERVENTIONS AND EXPOSURES: During the clinical trial, @entity1 were randomly assigned to receive intensive therapy (n   =   711) aimed at achieving glycemia as close to the nondiabetic range as safely possible, or conventional therapy (n   =   730) with the goal of avoiding symptomatic @entity4053 and @entity4854 . At the end of the DCCT, after a mean of 6.5 years, intensive therapy was taught and recommended to all @entity1 and @entity6 care was returned to personal physicians. MAIN OUTCOMES AND MEASURES: Total and cause-specific mortality was assessed through annual contact with family and friends and through records over 27 years' mean follow-up. RESULTS: Vital status was ascertained for 1429 (99.2%) @entity1 . There were 107 @entity204 , 64 in the conventional and 43 in the intensive group. The absolute risk difference was -109 per 100,000 @entity1 -years (95% CI, -218 to -1), with lower all-cause mortality risk in the intensive therapy group (hazard ratio [HR]   =   0.67 [95% CI, 0.46-0.99]; P   =   .045). Primary causes of @entity204 were @entity65 (24 @entity204 ; 22.4%), @entity5 (21 @entity204 ; 19.6%), @entity2412 (19 @entity204 ; 17.8%), and accidents or suicide (18 @entity204 ; 16.8%). Higher levels of glycated hemoglobin (HbA1c) were associated with all-cause mortality (HR   =   1.56 [95% CI, 1.35-1.81 per 10% relative increase in HbA1c]; P   <   .001), as well as the development of @entity633 (HR   =   2.20 [95% CI, 1.46-3.31]; P   <   .001). CONCLUSIONS AND RELEVANCE: After a mean of 27 years' follow-up of @entity1 with type 1 @entity6 , 6.5 years of initial intensive @entity6 therapy was associated with a modestly lower all-cause mortality rate when compared with conventional therapy. TRIAL REGISTRATION: clinicaltrials.gov Identifiers: NCT00360815 and NCT00360893.
