Modern-Day Clinical Course of Type 1 Diabetes Mellitus After 30 Years' Duration

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Abstract
The clinical course of type 1 diabetes mellitus (T1DM), including its treatment, metabolic outcomes, and long-term clinical complications, has changed dramatically in the past 20 years. Treatment innovations, including multiple daily injection regimens, continuous subcutaneous insulin infusion with external pumps, new insulin analogues with more physiologic pharmacokinetic characteristics, and wide-spread self-monitoring, and improved treatment of comorbidities such as hypertension and dyslipidemia, have all contributed to changes in the management of T1DM. Moreover, the Diabetes Control and Complications Trial (DCCT)1 and its long-term observational follow-up, the Epidemiology of Diabetes Interventions and Complications (EDIC) study,2 and other clinical trials3 have demonstrated the powerful effects of more physiologic control of glycemia on microvascular and macrovascular disease.3-7 All of these changes are projected to change the clinical course of T1DM. Unfortunately, most of the published descriptions of the clinical course of T1DM are either outdated, based on observations in small-sized populations, or rely on self-reported complications.8-12 Although several recent studies have reported declines in complications over time, they represent single-center experience and/or do not fully reflect the potential impact of intensive management.13-16