Intensive diabetes care cuts kidney complications
CHICAGO (Reuters) - Early, aggressive treatment of type 1 diabetes cut the risk of kidney disease in half in a study that followed a group of diabetics since the 1980s, U.S. researchers said on Saturday.
The findings, published in the New England Journal of Medicine, underscored the need for newly diagnosed diabetics to keep their blood sugar at near-normal levels.
The researchers followed more than 1,400 type 1 diabetics who entered the study when they were in the very earliest stages of the disease. Those who were treated intensively -- at least three shots of insulin a day or using an insulin pump -- were only half as likely decades later to have developed kidney disease than those who got the standard treatment, they found.
"Achieving near-normal glucose levels in type 1 diabetes can be challenging," said Dr. Ian de Boer, a kidney specialist at the University of Washington in Seattle, who is presenting his findings at the American Society of Nephrology's annual meeting in Philadelphia.
"But our study provides strong evidence that reinforces the benefits of reaching the goal as early as possible to slow or prevent kidney disease and other complications," he said in a statement.
Type 1 diabetes, formerly called juvenile diabetes, is less common than type 2 diabetes, the form of the disease linked to obesity and lack of exercise.
The researchers noted that their findings apply only to type 1 diabetes, which makes up about 5 to 10 percent of the 26 million people in the United States with diabetes.
Kidney disease is a major complication of type 1 diabetes, an autoimmune disease in which the body destroys its own ability to make insulin, rendering sufferers unable to properly break down sugar. Insulin is a hormone that regulates movement of sugar, the body's main source of fuel, into cells.
People with the condition must frequently monitor and take insulin to regulate blood sugar and prevent diabetic complications. An estimated three million Americans have type 1 diabetes, usually diagnosed in childhood or in young adults.
The findings come from a long-running study of 1,441 people with type 1 diabetes. Originally, they were enrolled in a study from 1983 to 1989 that compared the effects of aggressive treatment that aimed at getting people to achieve near-normal blood sugar, and a group that got usual care.
People in the study were aged 13 to 39 when they started and had no or only slight complications from the disease. Those who got conventional therapy were advised to avoid having episodes of low or high blood sugar using one or two daily insulin injections.
When the study ended 1993, all participants were encouraged to join a follow-up study. Those who were in the conventional therapy group were taught to do the intensive treatment. People were then put back under the care of their regular doctors.
After an average of 22 years of follow up, 46 people who had been in the conventional treatment group developed severe kidney problems and 16 had kidney failure. That compared with 24 cases of severe kidney disease among those who were in the intensive treatment group and eight cases of kidney failure.
That represents a 50 percent reduction in the risk of kidney complications, the team said.
The National Institute of Diabetes and Digestive and Kidney Diseases, part of the U.S. government's National Institutes of Health, backed the study.
"The full benefit of treatment may not be seen for decades, especially for complications of diabetes, such as kidney disease, which can progress slowly but have devastating consequences," said institute head Dr. Griffin Rodgers.
SOURCE: http://bit.ly/valRli New England Journal of Medicine, online November 12, 2011.
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