Rachel Miller
The goal of this observational study is to better understand how the amount of insulin people with type 1 diabetes are using relates to blood glucose control and the risk of complications. The main questions this study aims to answer are: 1) Is insulin dose related to the long-term risk of developing heart disease, kidney disease and other complications in people with type 1 diabetes, after accounting for blood glucose? and 2) Does insulin dose relate to early signs of heart and kidney disease (i.e., disease that is not clinically detectable) in people with type 1 diabetes who are using modern diabetes management regimens?
Study Aim 1 will use existing data from the prospective Pittsburgh Epidemiology of Diabetes Complications (EDC) study cohort, comprising 658 study participants who were diagnosed with type 1 diabetes in childhood (\<17 years old) and followed for health outcomes and clinical measures for up to 37 years beginning in 1986. Prospective analyses of this existing data will be conducted. Existing data from the DCCT/EDIC study will be used to externally validate EDC study findings. Study Aim 2 will collect new data from 80 EDC study participants without a history of cardiovascular disease, kidney fa…
Inclusion Criteria: * Study Aim 1 - All existing participants of the Pittsburgh EDC study * Study Aim 2 - Existing participants of the Pittsburgh EDC study who were alive and not withdrawn as of the most recent (2023-24) survey follow-up Exclusion Criteria: * Study Aim 1 - For each outcome of interest, individuals who already had the outcome at study baseline. * Study Aim 2 - History of major cardiovascular disease, kidney failure, or pancreatic transplant
Aim 1: Participants will be observed under their self-reported, routine, physician-directed insulin doses using existing historical data since 1986-88. Aim 2: Data on routine, physician-directed insulin dose over the past 2 weeks will be downloaded from insulin delivery devices (pumps, smart pens). Participants not using such devices will complete manual insulin dose log sheets for 2 weeks.
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