(Ivanhoe Newswire) -- The outlook for people with long-standing type 1
diabetes has greatly improved in the past 20 years due to a better understanding
of the importance of intensive glucose control as well as advances in insulin
formulations, insulin delivery, glucose monitoring and the treatment of
cardiovascular risk factors, concludes a study which updates information on the
clinical course of type 1 diabetes.
Formerly called juvenile-onset diabetes or insulin-dependent diabetes, type 1
diabetes develops when the body's immune system destroys the pancreatic beta
cells that make the hormone insulin that regulates blood glucose. This form of
diabetes usually arises in children and young adults, though it can occur at any
age. Management involves keeping blood glucose levels as close to normal as
possible with three or more insulin injections a day or treatment with an
insulin pump, careful monitoring of glucose, and close attention to diet and
exercise. Of the nearly 24 million people in the U.S. who have diabetes, in
adults type 1 diabetes accounts for 5 to 10 percent of diagnosed cases.
"The demonstration that near-normal glucose control substantially lowers
microvascular and cardiovascular complications has heralded a new era of type 1
diabetes care," lead author David M. Nathan, M.D., of Massachusetts General
Hospital, is quoted as saying. Dr. Nathan is also co-chair of the landmark
Diabetes Control and Complications Trial (DCCT) and its follow-up study, the
Epidemiology of Diabetes Interventions and Complications (EDIC).
"The remarkable improvement in long-term outcomes achieved with intensive
glucose control,” said Nathan, “should encourage clinicians and patients alike
to implement intensive therapy as early in the course of type 1 diabetes as
possible."
The study compared overall rates of eye, kidney and cardiovascular complications
in three groups of people diagnosed with type 1 diabetes an average of 30 years
earlier. Two groups consisted of DCCT/EDIC participants randomly assigned to
intensive glucose control or to conventional control. The third group was a
subset of patients in the Pittsburgh Epidemiology of Diabetes Complications (EDC)
study, who were matched to the other participants by age, duration of diabetes
and degree of eye damage.
After 30 years of diabetes, participants randomly assigned to intensive glucose
control 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
cardiovascular disease.
"Better treatment of blood pressure and cholesterol is also helping to reduce
complication rates," Trevor Orchard, M.D., of the University of Pittsburgh, who
heads the EDC study was quoted as saying.
"After 30 years of diabetes, fewer than 1 percent of those receiving intensive
glucose control ... significantly impaired vision, kidney failure or needed a
limb amputation due to diabetes," Saul Genuth, M.D., of Case Western University,
who co-chairs the EDIC study, was quoted as saying. "Tight control is difficult
to achieve and maintain, but its benefits have changed the course of diabetes."
"When intensive therapy, now the standard of care, is implemented early in the
course of diabetes,” said Nathan, “most patients with type 1 diabetes should be
able to avoid the disastrous long-term complications that were so common in the
past."
SOURCE: Archives of Internal Medicine, July 27, 2009
