Clinical Factors Associated With Resistance to Microvascular Complications in Diabetic Patients of Extreme Disease Duration

The 50-year Medalist Study

  1. Hillary A. Keenan, PHD1,
  2. Tina Costacou, PHD2,
  3. Jennifer K. Sun, MD13,
  4. Alessandro Doria, MD, PHD1,
  5. Jerry Cavellerano, OD, PHD13,
  6. Joseph Coney, MD1,
  7. Trevor J. Orchard, MBBCH, MMEDSCI2,
  8. Lloyd Paul Aiello, MD, PHD13 and
  9. George L. King, MD14
  1. 1Joslin Diabetes Center, Boston, Massachusetts
  2. 2Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
  3. 3Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
  4. 4Department of Medicine, Harvard Medical School, Boston, Massachusetts
  1. Address correspondence and reprint requests to George L. King, MD, Joslin Diabetes Center, One Joslin Place, Boston, MA 02215. E-mail: george.king{at}

Duration of diabetes and degree of hyperglycemia have consistently been identified as predictors of retinopathy and nephropathy (1–6). Multiple studies have concluded that nearly all individuals with type 1 diabetes will develop some level of retinopathy within 20 years of diagnosis (2,4,5,7,8). However, the study by Bain et al. (9) described the Golden Years study group of type 1 diabetic patients with ≥50 years of diabetes duration who appeared to be protected against nephropathy and large vessel disease but not against retinopathy. However, the associations of glycemic control, duration of disease, and vascular complications were not evaluated (9). This report characterizes the prevalence of complications and associated risk factors in a large number of individuals who have been insulin dependent for ≥50 years.


The 50-Year Medal Program of the Joslin Diabetes Center (JDC) was initiated to recognize JDC or non-JDC patients who survived ≥50 years with type 1 diabetes. This was documented by either medical record or family report. This was a survey-based cross-sectional study of subjects living in the U.S. who were awarded the Joslin Medal between 1997 and 2003. The Committee on Human Subjects at the JDC approved this study. The patients were questioned regarding the presence and absence of eye, kidney, and peripheral neuropathy.

Clinical validation of retinopathy

Self-reported retinopathy was validated by comparing retinal clinical examination and fundus photography (seven-standard field), in a subset (n = 92, 28%) of the 326 subjects, to the questionnaire, with the worse eye used for analysis. Grading was performed by two experienced ophthalmologists and discrepancies adjudicated by consensus. Descriptive analyses were performed using the Statistical Analysis System (version 8.2; SAS, Cary, NC). The Cochran-Armitage test was used to test for trends of categorical …

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  1. Diabetes Care vol. 30 no. 8 1995-1997
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