The relationship of glycemic exposure (HbA1c) to the risk of development and XXXX in the @entity6 control and complications trial.

@entity4051 @entity1 @entity6 @entity8518 @entity1723 @entity989 @entity413
The @entity6 Control and Complications Trial (DCCT) demonstrated that a regimen of intensive therapy aimed at maintaining near-normal blood @entity413 values markedly reduces the risks of development or @entity989 and other complications of @entity1723 ( @entity1723 ) when compared with a conventional treatment regimen. This report presents an epidemiological assessment of the association between levels of glycemic exposure (HbA1c) before and during the DCCT with the risk of @entity989 progression within each treatment group. The initial level of HbA1c observed at eligibility screening as an index of pre-DCCT glycemia and the duration of @entity1723 on entry were the dominant baseline predictors of the risk of progression. The shorter the duration of @entity1723 on entry, the greater were the benefits of intensive therapy. In each treatment group, the mean HbA1c during the trial was the dominant predictor of @entity989 progression, and the risk gradients were similar in the two groups; a 10% lower HbA1c (e.g., 8 vs. 7.2%) is associated with a 43% lower risk in the intensive group and a 45% lower risk in the conventional group. These risk gradients applied over the observed range of HbA1c values and were unaffected by adjustment for other covariates. Over the range of HbA1c achieved by DCCT intensive therapy, there does not appear to be a level of glycemia below which the risks of @entity989 progression are eliminated. The change in risk over time, however, differed significantly between the treatment groups, the risk increasing with time in the study in the conventional group but remaining relatively constant in the intensive group. The risks were compounded by a multiplicative effect of the level of HbA1c with the duration of exposure (time in study). Total glycemic exposure was the dominant factor associated with the risk of @entity989 progression. When examined simultaneously within each treatment group, each of the components of pre-DCCT glycemic exposure (screening @entity4051 c value and @entity1723 duration) and glycemic exposure during the DCCT (mean HbA1c, time in study, and their interaction) were significantly associated with risk of @entity989 progression. Similar results also apply to other retinopathic, @entity8518 , and neuropathic outcomes. The recommendation of the DCCT remains that intensive therapy with the goal of achieving near-normal glycemia should be implemented as early as possible in as many @entity1723 @entity1 as is safely possible.
