Metabolic memory and its possible mechanisms are reviewed. In clinical practice in type 1 diabetes the concept of metabolic memory has developed largely from the observations of the Epidemiology of Diabetes Interventions and Complications (EDIC) study, which followed the Diabetes Control and Complications Trial (DCCT). In the former intensive treatment group, after 10 years follow-up, when glycated haemoglobin levels had converged completely, there was less progression of retinopathy and lower rates of proliferative retinopathy. Diabetic nephropathy and neuropathy were similarly reduced. The combined DCCT and EDIC studies showed a reduction in the risk of any cardiovascular disease. Good early metabolic control affects outcome for at least 10 years and it is hoped this information can be translated into clinical practice to reduce significantly the burden of long-term complications.
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