REVIEW
SA JOURNAL OF DIABETES & VASCULAR DISEASE
104
VOLUME 7 NUMBER 3 • SEPTEMBER 2010
on coronary artery calcification at 7–9 years follow-up in the EDIC
study
22
and, after six years in the EDIC study, progression of carotid
artery intima–media thickening was less in the former intensively
treated group.
23
Conclusions
There are long-term consequences of glycaemic control early in the
course of type 1 diabetes which show that good control protects
against both microvascular and macrovascular complications
occurring later. The effect is not necessarily a memory effect but
rather a consequence or legacy of metabolic control in the early
stages of type 1 diabetes. The mechanism of this legacy is probably
irreversible, or very slowly reversible, vascular damage – similar to
the legacy of smoking. The metabolic memory of glycaemic control
in the early stages of type 1 diabetes causes a shift in the time
relationship of duration of diabetes and incidence of long-term
complications. Failure to maintain adequate control of diabetes in
the first few years of type 1 diabetes cannot be excused by the
knowledge that complications may take many years to develop.
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Key messages
• Good glycaemic control in the first six years of type
1 diabetes is highly beneficial in delaying long-term
complications
• Metabolic memory may contribute to the finding of
long-term complications early or late in the course of the
disease
• Metabolic memory may contribute to the mildness/
severity of long-term complications
• Metabolic memory should not be used as a reason for
failing to improve diabetic control at any stage of the
disease
