Early, intense therapy cuts type 1 diabetes risks
CHICAGO (Reuters) - People with type 1 diabetes who can get their blood sugar to near-normal levels can cut their long-term risk of serious complications in half, U.S. researchers said on Monday.
For people with type 1 diabetes -- formerly called juvenile diabetes -- intervening early with aggressive measures to control blood sugar worked far better than conventional care at reducing blindness, kidney failure, and heart disease in people who had lived with the disease for at least three decades.
"I think this is extremely exciting," said Dr. Trevor Orchard of the University of Pittsburgh, who worked on the study published in the Archives of Internal Medicine.
"This halving virtually of the major complications ... I think is a very dramatic improvement and demonstrates that good intensive therapy from early on is very beneficial," Orchard said in a telephone interview.
Type 1 diabetes represents about 10 percent of the 180 million cases of diabetes globally. It occurs when the immune system goes haywire and starts destroying insulin-producing cells in the pancreas needed to control blood sugar.
These patients typically need daily insulin to control their diabetes, which is a different disease from the far more common type 2 diabetes -- a condition linked with obesity and lack of exercise.
Advanced insulin formulations, insulin pumps, and continuous glucose monitors, along with better control of blood pressure and heart disease, have vastly improved the outlook of people with type 1 diabetes, the team said. The total global market for treating both types of diabetes was $25 billion in 2007.
The researchers compared overall rates of eye, kidney and cardiovascular complications in people with type 1 diabetes.
One group took insulin shots at least three times a day and took glucose readings at least four times a day with the goal of achieving a long-term average blood sugar or A1c reading of 7, which is in the normal range.
A second group had conventional care, which was basically enough treatment to control diabetes symptoms. People in this group had an average A1c of 9.
The researchers followed the patients for 30 years, with the two groups staying on their treatment regimens from 1983 to 1989. Those who had been in the intensive group had about half the rate of eye damage compared to those assigned to conventional glucose control.
They also had lower rates of kidney damage and fewer cases of heart attacks, strokes, chest pain or blocked arteries compared to those on conventional glucose management.
Orchard said the findings mean that if people had stayed on the intensive therapy, the benefits might have been greater.
"These data demonstrate I think quite clearly that with reasonable control, you can go a long, long time without any major complications," he said.
Other studies of intensive glucose control in older people with type 2 diabetes have been less conclusive, and some have even shown higher risks of heart problems.
Orchard said the findings in this study in younger people with type 1 diabetes suggest intensive glucose control may work best when started early.
SOURCE: Archives of Internal Medicine, July 27, 2009.
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