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Background: Clinical treatment goals of type 1 diabetesmellitus(T1DM)havechangedsincetheDiabetesControl and Complications Trial (DCCT) demonstrated reduced long-term complications with intensive diabetes therapy. There have been few longitudinal studies to describe the clinical course of T1DM in the age of intensive therapy. Our objective was to describe the currentday clinical course of T1DM. Methods: An analysis of the cumulative incidence of long-term complications was performed. The DCCT (1983-1993) assigned patients to conventional or intensive therapy. Since 1993, the DCCT has been observational, and intensive therapy was recommended for all patients.ThePittsburghEpidemiologyofDiabetesComplications (EDC) study is an observational study of patients with T1DM from Allegheny County, Pennsylvania. The study population comprised the DCCT T1DM cohort(N=1441)andasubsetoftheEDCcohort(n=161) selected to match DCCT entry criteria. In the DCCT, intensive therapy aimed for a near-normal glycemic level with3ormoredailyinsulininjectionsoraninsulinpump. Conventional therapy, with 1 to 2 daily insulin injections, was not designed to achieve specific glycemic targets. Main outcome measures included the incidences of proliferative retinopathy, nephropathy (albumin excretion rate 300 mg/24 h, creatinine level 2 mg/dL [to convert to micromoles per liter, multiply by 88.4], or renal replacement), and cardiovascular disease. Results: After 30 years of diabetes, the cumulative incidences of proliferative retinopathy, nephropathy, and cardiovascular disease were 50%, 25%, and 14%, respectively, in the DCCT conventional treatment group, and 47%,17%,and14%,respectively,intheEDCcohort.The DCCT intensive therapy group had substantially lower cumulativeincidences(21%,9%,and9%)andfewerthan 1% became blind, required kidney replacement, or had an amputation because of diabetes during that time. Conclusion: The frequencies of serious complications in patients with T1DM, especially when treated intensively, are lower than that reported historically. Trial Registration: clinicaltrials.gov Identifiers: NCT00360815 and NCT00360893