{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T08:27:29Z","timestamp":1792744049660,"version":"4.5.0"},"reference-count":19,"publisher":"American Diabetes Association","issue":"5","license":[{"start":{"date-parts":[[2019,4,22]],"date-time":"2019-04-22T00:00:00Z","timestamp":1555891200000},"content-version":"vor","delay-in-days":49,"URL":"http:\/\/www.diabetesjournals.org\/content\/license"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["U01-DK-094176"],"award-info":[{"award-number":["U01-DK-094176"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["U01-DK-094157"],"award-info":[{"award-number":["U01-DK-094157"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The Diabetes Control and Complications Trial (DCCT) demonstrated that intensive therapy reduced the development and progression of retinopathy in type 1 diabetes (T1D) compared with conventional therapy. The Epidemiology of Diabetes Interventions and Complications (EDIC) study observational follow-up showed persistent benefits. In addition to glycemia, we now examine other potential retinopathy risk factors (modifiable and nonmodifiable) over more than 30 years of follow-up in DCCT\/EDIC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>The retinopathy outcomes were proliferative diabetic retinopathy (PDR), clinically significant macular edema (CSME), and ocular surgery. The survival (event-free) probability was estimated using the Kaplan-Meier method. Cox proportional hazards models assessed the association between risk factors and subsequent risk of retinopathy. Both forward- and backward-selection approaches determined the multivariable models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Rate of ocular events per 1,000 person-years was 12 for PDR, 14.5 for CSME, and 7.6 for ocular surgeries. Approximately 65%, 60%, and 70% of participants remained free of PDR, CSME, and ocular surgery, respectively. The greatest risk factors for PDR in descending order were higher mean HbA1c, longer duration of T1D, elevated albumin excretion rate (AER), and higher mean diastolic blood pressure (DBP). For CSME, risk factors, in descending order, were higher mean HbA1c, longer duration of T1D, and greater age and DBP and, for ocular surgeries, were higher mean HbA1c, older age, and longer duration of T1D.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Mean HbA1c was the strongest risk factor for the progression of retinopathy. Although glycemic control is important, elevated AER and DBP were other modifiable risk factors associated with the progression of retinopathy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/dc18-2308","type":"journal-article","created":{"date-parts":[[2019,4,22]],"date-time":"2019-04-22T22:45:31Z","timestamp":1555973131000},"page":"875-882","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":187,"title":["Risk Factors for Retinopathy in Type 1 Diabetes: The DCCT\/EDIC Study"],"prefix":"10.2337","volume":"42","clinical-trial-number":[{"clinical-trial-number":"nct00360893","registry":"10.18810\/clinical-trials-gov","type":"results"},{"clinical-trial-number":"nct00360815","registry":"10.18810\/clinical-trials-gov","type":"results"}],"author":[{"given":"Dean P.","family":"Hainsworth","sequence":"first","affiliation":[{"name":"Mason Eye Institute, University of Missouri, Columbia, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4944-7968","authenticated-orcid":false,"given":"Ionut","family":"Bebu","sequence":"additional","affiliation":[{"name":"Biostatistics Center, The George Washington University, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lloyd P.","family":"Aiello","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Joslin Diabetes Center, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Sivitz","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Iowa, Iowa City, IA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7376-6870","authenticated-orcid":false,"given":"Rose","family":"Gubitosi-Klug","sequence":"additional","affiliation":[{"name":"Rainbow Babies and Children\u2019s Hospital, Cleveland, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Malone","sequence":"additional","affiliation":[{"name":"Diabetes Center, University of South Florida, Tampa, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil H.","family":"White","sequence":"additional","affiliation":[{"name":"Pediatrics, Washington University, St. Louis, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald","family":"Danis","sequence":"additional","affiliation":[{"name":"University of Wisconsin, Madison, WI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3183-4062","authenticated-orcid":false,"given":"Amisha","family":"Wallia","sequence":"additional","affiliation":[{"name":"Department of Medicine, Northwestern University, Evanston, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyu","family":"Gao","sequence":"additional","affiliation":[{"name":"Biostatistics Center, The George Washington University, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Barkmeier","sequence":"additional","affiliation":[{"name":"University of New Mexico, Albuquerque, NM"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arup","family":"Das","sequence":"additional","affiliation":[{"name":"University of New Mexico, Albuquerque, NM"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shriji","family":"Patel","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center, Nashville, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas W.","family":"Gardner","sequence":"additional","affiliation":[{"name":"University of Michigan Kellogg Eye Center, Ann Arbor, MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9838-2841","authenticated-orcid":false,"given":"John M.","family":"Lachin","sequence":"additional","affiliation":[{"name":"Biostatistics Center, The George Washington University, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the Diabetes Control and Complications Trial (DCCT)\/Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2019,3,4]]},"reference":[{"key":"2022031303250232500_B1","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1056\/NEJM199309303291401","article-title":"The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus","volume":"329","author":"Nathan","year":"1993","journal-title":"N Engl J Med"},{"key":"2022031303250232500_B2","doi-asserted-by":"crossref","first-page":"99","DOI":"10.2337\/diacare.22.1.99","article-title":"Epidemiology of Diabetes Interventions and Complications (EDIC). Design, implementation, and preliminary results of a long-term follow-up of the diabetes control and complications trial cohort","volume":"22","author":"The DCCT\/EDIC Research Group","year":"1999","journal-title":"Diabetes Care"},{"key":"2022031303250232500_B3","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1056\/NEJM200002103420603","article-title":"Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy","volume":"342","author":"Lachin","year":"2000","journal-title":"N Engl J Med"},{"key":"2022031303250232500_B4","doi-asserted-by":"crossref","first-page":"1707","DOI":"10.1001\/archopht.126.12.1707","article-title":"Prolonged effect of intensive therapy on the risk of retinopathy complications in patients with type 1 diabetes mellitus: 10 years after the Diabetes Control and Complications Trial","volume":"126","author":"White","year":"2008","journal-title":"Arch Ophthalmol"},{"key":"2022031303250232500_B5","first-page":"631","article-title":"Effect of intensive diabetes therapy on the progression of diabetic retinopathy in patients with type 1 diabetes: 18 years of follow-up in the DCCT\/EDIC","volume-title":"Diabetes","author":"Lachin","year":"2015"},{"key":"2022031303250232500_B6","doi-asserted-by":"crossref","first-page":"530","DOI":"10.2337\/diab.35.5.530","article-title":"The Diabetes Control and Complications Trial (DCCT). Design and methodologic considerations for the feasibility phase","volume":"35","author":"The DCCT Research Group","year":"1986","journal-title":"Diabetes"},{"key":"2022031303250232500_B7","doi-asserted-by":"crossref","first-page":"2643","DOI":"10.1056\/NEJMoa052187","article-title":"Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes","volume":"353","author":"Nathan","year":"2005","journal-title":"N Engl J Med"},{"key":"2022031303250232500_B8","doi-asserted-by":"crossref","first-page":"2267","DOI":"10.1093\/clinchem\/33.12.2267","article-title":"Feasibility of centralized measurements of glycated hemoglobin in the Diabetes Control and Complications Trial: a multicenter study","volume":"33","author":"The DCCT Research Group","year":"1987","journal-title":"Clin Chem"},{"key":"2022031303250232500_B9","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.2215\/CJN.07901109","article-title":"Comparison of urinary albumin-creatinine ratio and albumin excretion rate in the diabetes control and complications trial\/epidemiology of diabetes interventions and complications study","volume":"5","author":"Younes","year":"2010","journal-title":"Clin J Am Soc Nephrol"},{"key":"2022031303250232500_B10","doi-asserted-by":"crossref","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate","volume":"150","author":"Levey","year":"2009","journal-title":"Ann Intern Med"},{"key":"2022031303250232500_B11","doi-asserted-by":"crossref","first-page":"1370","DOI":"10.2337\/db15-1517","article-title":"Risk factors for cardiovascular disease in type 1 diabetes","volume":"65","author":"Diabetes Control and Complications Trial\/Epidemiology of Diabetes Interventions and Complications (DCCT\/EDIC) Research Group","year":"2016","journal-title":"Diabetes"},{"key":"2022031303250232500_B12","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1016\/S0161-6420(13)38014-2","article-title":"Fundus photographic risk factors for progression of diabetic retinopathy. ETDRS report number 12","volume":"98","author":"Early Treatment Diabetic Retinopathy Study Research Group","year":"1991","journal-title":"Ophthalmology"},{"key":"2022031303250232500_B13","doi-asserted-by":"crossref","first-page":"1722","DOI":"10.1056\/NEJMoa1409463","article-title":"Intensive diabetes therapy and ocular surgery in type 1 diabetes","volume":"372","author":"Aiello","year":"2015","journal-title":"N Engl J Med"},{"key":"2022031303250232500_B14","doi-asserted-by":"crossref","first-page":"1623","DOI":"10.1002\/(SICI)1097-0258(19980730)17:14<1623::AID-SIM871>3.0.CO;2-S","article-title":"A simple method of sample size calculation for linear and logistic regression","volume":"17","author":"Hsieh","year":"1998","journal-title":"Stat Med"},{"key":"2022031303250232500_B15","volume-title":"Biostatistical Methods: The Assessment of Relative Risks","author":"Lachin","year":"2011","edition":"2nd ed."},{"key":"2022031303250232500_B16"},{"key":"2022031303250232500_B17","volume-title":"Model Selection and Model Averaging","author":"Claeskens","year":"2008"},{"key":"2022031303250232500_B18","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1002\/(SICI)1097-0258(19970228)16:4<385::AID-SIM380>3.0.CO;2-3","article-title":"The lasso method for variable selection in the Cox model","volume":"16","author":"Tibshirani","year":"1997","journal-title":"Stat Med"},{"key":"2022031303250232500_B19","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1111\/pedi.12166","article-title":"A decade of temporal trends in overweight\/obesity in youth with type 1 diabetes after the Diabetes Control and Complications Trial","volume":"16","author":"Baskaran","year":"2015","journal-title":"Pediatr Diabetes"}],"container-title":["Diabetes Care"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/care.diabetesjournals.org\/syndication\/doi\/10.2337\/dc18-2308","content-type":"unspecified","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/42\/5\/875\/553182\/dc182308.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/42\/5\/875\/553182\/dc182308.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,13]],"date-time":"2022-03-13T03:54:23Z","timestamp":1647143663000},"score":1,"resource":{"primary":{"URL":"https:\/\/diabetesjournals.org\/care\/article\/42\/5\/875\/40471\/Risk-Factors-for-Retinopathy-in-Type-1-Diabetes"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,3,4]]},"references-count":19,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2019,3,4]]},"published-print":{"date-parts":[[2019,5,1]]}},"URL":"https:\/\/doi.org\/10.2337\/dc18-2308","relation":{},"ISSN":["0149-5992","1935-5548"],"issn-type":[{"value":"0149-5992","type":"print"},{"value":"1935-5548","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,3,4]]}}}