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Lloyd Aiello, Wanjie Sun, Patricia Cleary, John Lachin, Sapna Gangaputra, Ronald Klein, Arup Das, Szilard Kiss, Amitha Domalpally, Ronald Danis, ; Intensive Diabetes Therapy Reduces Ocular Surgeries in Patients with Type 1 Diabetes: twenty-eight year followup of the Diabetes Control and Complications Trial / Epidemiology of Diabetes Interventions and Complications study (DCCT/EDIC). Invest. Ophthalmol. Vis. Sci. 2013;54(15):4024.
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The DCCT/EDIC study established the beneficial impact of intensive diabetes therapy (INT) on retinopathy onset and progression. However, the effects of diabetes treatment on the incidence of ocular surgery have not been explored. This report compares the long-term effect of former INT vs. conventional therapy (CON) on the incidence of ocular surgeries 28 years after the initiation of DCCT (1983-2011).
Annual visits recorded the history of surgical procedures in either eye over the 28 years after initiation of the DCCT.
During DCCT (1983-93), HbA1c was ~7% in INT and 9% in CON, but during EDIC there were no statistical differences from Year 4 to date. Over the 23-year median followup, 63 of 711 INT and 98 of 730 CON subjects had at least one ocular surgery for an incidence of 3.95 and 6.24 per 1000 subject-years (P<0.0001). Ocular surgeries included cataract extraction (42 INT, 61 CON subjects), vitrectomy (29, 50), glaucoma-related (9, 14), other cornea-related (2, 3), posterior capsulotomy (3, 4) and enucleation (1, 1). Total surgeries in both eyes were 138 (INT) and 180 (CON) for an incidence of 8.01 and 11.64 per 1000 subject-years, respectively (P<0.0001). INT subjects had fewer overall surgeries (P=0.035) and fewer different surgery types (p=0.015) than CON subjects. INT was associated with a 48% risk (hazard) reduction in experiencing any ocular surgery (95% confidence interval [CI], 28 to 62%; P=0.0001) after adjustment for age, gender, diabetes duration, HbA1c, retinopathy and visual acuity at DCCT baseline. INT was associated with 48% (P=0.002) and 44% (P=0.016) adjusted risk reduction of cataract extraction and vitrectomy, respectively (CI 22-66% and 10-65%). The beneficial effect of INT on the risk of any ocular surgery or cataract extraction or vitrectomy was fully accounted for by adjustment for updated mean HbA1c or retinopathy level. Higher A1c, retinopathy, macular edema, poorer visual acuity, nephropathy, neuropathy and hypertension were each independently associated with increased risk of ocular surgery.
Intensive insulin therapy reduces the long-term risk of ocular surgery in patients with type 1 diabetes.
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