American Journal of Epidemiology Vol. 143, No. 5: 431-441
Copyright © 1996 by The Johns Hopkins University School of Hygiene and Public Health
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Incidence of Complications in Insulin-dependent Diabetes Mellitus: A Survival Analysis
1Graduate School of Public Health, University of Pittsburgh Pittsburgh, PA.
2Department of Endocrinology, Children's Hospital of Pittsburgh Pittsburgh, PA
Reprint requests to Dr. Trevor J. Orchard, 5th Floor, Rangos Research Center, 3460 Fifth Avenue, Pittsburgh, PA 15213.
The authors used 4-year incidence data from the Pittsburgh Epidemiology of Diabetes Complications (EDC) Study to investigate the wider applicability of recent research findings that demonstrate an association between glycemic control and insulin-dependent diabetes mellitus (IDDM) complications. EDC subjects participated in a clinical examination at baseline (1986–1988) and were followed up every 2 years. Results demonstrated that, during the first 4 years of follow-up, subjects who were in "poor" control (glycosylated hemoglobin (GHb) 
11%) at baseline were significantly (p < 0.001) more likely to develop microalbuminuria, proliferative retinopathy, and distal symmetrical polyneuropathy (DSP), compared with subjects who were in "fair" control (GHb <11%). Subjects who were in poor control were somewhat more likely to develop overt nephropathy (p = 0.08) and renal failure (p = 0.085) during follow-up; however, no associations were observed with either coronary heart disease or lower extremity arterial disease (LEAD). These results confirm the strong association between prior glycemic control and the onset of microalbuminuria, proliferative retinopathy, and DSP observed in the Diabetes Control and Complications Trial study. However, the results of the study suggest weaker associations for the later stages of renal disease, and little relation was seen between glycemic control and LEAD or coronary disease. Other risk factors may be more important for the development of the later complications of IDDM. Further follow-up is necessary in order to rule out type II error. Am J Epidemiol 1996;143:431–41.
coronary disease; diabetes mellitus; insulin-dependent; diabetic nephropathies; diabetic neuropathies; diabetic retinopathy; survival analysis
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