This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. This study follows patients already treated and evaluated through the Diabetes Control and Complications Trial (DCCT). All patients followed in the DCCT were asked to participate in this study at Joslin Diabetes Center and the other 28 centers in North America. The overall goal of the project is to examine factors associated with the development of macrovascular, retinopathic, nephropathic, and neuropathic complications of IDDM, or Type 1 diabetes. This is a natural history study so that all volunteers will be followed for 10 years without regard to assigned treatment status in the DCCT trial. The major objectives of the study include: 1) Determination of the long term course of atherosclerotic cardiovascular disease in IDDM 2) To study the effects of potential risk factors including those established in non-diabetic and IDDM populations on the development and progression of cardiovascular disease in IDDM 3) To study the long term evolution of microalbuminuria and clinical nephropathy in an already characterized population of persons with IDDM 4) To examine the long term effects of early diabetes treatment (conventional vs. intensive) on subsequent development and progression of nephropathy and neuropathy. 5) To study the health care provided to IDDM patients in the US and Canada over time. Patients will be followed annually for assessment of cardiovascular, peripheral vascular, neuropathic, retinopathic, metabolic, and health care delivery issues. In addition, patients will be evaluated on psychological and dietary questionnaires bi-annually by the investigator team and will receive fundus photographs on the 8th, 12th and 16th anniversary of randomization into the DCCT trial. Finally, hypoglycemic data will be gathered quarterly through telephone interviews and through a standardized face to face interview on an annual basis.
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