Lingering Effects of Hyperglycemia in Recently Diagnosed Diabetes During Long-term Follow-up of the DCCT/EDIC and UKPDS Cohorts: More Evidence That Early Control Matters
Bibliographic record
Abstract
The Diabetes Control and Complications Trial (DCCT) and the UK Prospective Diabetes Study (UKPDS) have given us fundamental insights into the natural history and management of diabetes (1,2). These include strong evidence that 1 ) enhanced glycemic management can limit some of the complications of diabetes, 2 ) there is a dose-response relationship between HbA1c levels and the risk of complications, and 3 ) a treatment target of <7.0% (<53 mmol/mol) HbA1c is realistic and appropriate. Continued observation of the randomized cohorts after the planned end of study has further shown that cardiovascular events and mortality, which could not be shown to be improved during the randomized treatment phases, were significantly reduced long after glucose control equalized in the two arms (3–5). In both studies glycemic control as assessed by HbA1c accounted statistically for most of the difference in outcomes. In three articles in this issue of Diabetes Care the DCCT and UKPDS investigators provide more information on the long-term effects of enhanced glycemic control early in the natural history of diabetes (6–8). In the first of two articles based on more than 20 years of additional observation of the DCCT cohorts in the Epidemiology of Diabetes Interventions and Complications (EDIC) study, Lachin and Nathan (6) report new analyses of data on microvascular complications. These add to previously reported evidence for persistence of lower rates of progression of microvascular disease in the originally intensively managed cohort, despite convergence of HbA1c values in the two groups soon after cessation of the randomized comparison of treatments. The investigators have previously termed this phenomenon “metabolic memory.” Here they further report a gradual waning of outcome differences after ∼10 years. They emphasize a distinction between the incremental effect on microvascular complications, which slowly declines, and the cumulative …
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.076 | 0.169 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.006 |
| Bibliometrics | 0.002 | 0.005 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.005 | 0.005 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.006 | 0.007 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".