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Rose A. Gubitosi-Klug, Wanjie Sun, Patricia Cleary, Lloyd P. Aiello, Arup Das, Larry D. Hubbard, Ronald Klein, William Tamborlane, DCCT/EDIC Study Group; Effects of Prior Intensive Insulin Therapy and Risk Factors on Visual Quality-of-Life in the DCCT/EDIC Cohort. Invest. Ophthalmol. Vis. Sci. 2011;52(14):602.
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In the Diabetes Control and Complications Trial (DCCT), intensive (INT) management of type 1 diabetes reduced the risk of development and progression of diabetic retinopathy compared to conventional (CONV) treatment; differences that were maintained during the Epidemiology of Diabetes Interventions and Complications (EDIC) observational study. To assess the effect of prior intensive treatment and risk factors on visual quality of life (VQOL) in this cohort, 1247 EDIC participants completed the National Eye Institute (NEI) Visual Functioning Questionnaire during EDIC years 13-16, twenty-six years after the start of the DCCT.
The composite VQOL, and sub-domains were scored on a scale of 0 to 100 corresponding to poor to excellent function. Quantile regression was used to assess the treatment/risk factor effect on median QOL score owing to the ordinal scoring and a skewed distribution.
The overall median VQOL across the former DCCT treatment groups was high, 95.3, IQR (90.9, 97.6). After adjustment for gender, age, and retinopathy level at DCCT baseline, the former INT group had a significant, albeit modest, improvement in overall VQOL compared to the former CONV group (median difference -0.7 [-1.3, -0.1], p = 0.02). In comparison to INT, rapid progression of diabetic retinopathy and related treatment interventions; declining visual acuity (VA) and renal function contributed to the mild impairment of VQOL in the former CONV group (explained treatment effect: 61%, 52%, and 33%, respectively, all P <.0001). Those with VA worse than 20/100 reported the lowest median VQOL (69). Older participants, females, and those employed as laborers reported significantly lower VQOL as well (P<0.05).
In the DCCT/EDIC cohort, VQOL remains high in both treatment groups. INT showed modestly better VQOL in association with improved retinopathy, visual acuity, and renal function. VA, among all risk factors, has the greatest impact on VQOL.
Clinical Trial: :
http://www.clinicaltrials.gov NCT00360815 and NCT00360893
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