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Tight Control Halves Complication Rates
July 31, 2009
Maintenance of blood glucose levels at a near-normal range beginning as soon as possible after diagnosis halves the rate of certain complications in people with long-standing Type 1 diabetes, according to research recently published in the Archives of Internal Medicine.
Using data from participants in the Diabetes Control and Complications Trial (DCCT), the Epidemiology of Diabetes Interventions and Complications (EDIC) study (a follow-up to the DCCT), and the Pittsburgh Epidemiology of Diabetes Complications (EDC) study, the researchers compared the rates of eye, kidney, and cardiovascular complications in three groups of people diagnosed with Type 1 diabetes an average of 30 years earlier. One group consisted of people assigned to intensive blood glucose control in the DCCT and EDIC (as defined in these studies, that means an HbA1c of 6% or less); a second group consisted of people assigned to conventional blood glucose control in the DCCT and EDIC; and a third group was comprised of people matched by age, duration of diabetes, and degree of eye damage to the DCCT and EDIC participants.
The investigators found that, after having diabetes for 30 years, people randomly assigned to intensive control in the DCCT had a 21% rate of eye damage, less than half the 50% rate of damage seen in people assigned to conventional blood glucose control in that study. Moreover, people from the intensive-control group had a 9% rate of kidney damage and a 9% rate of cardiovascular events, compared to a 25% rate of kidney damage and a 14% rate of cardiovascular events among those in the conventional control group. The rates of complications were also lower among people in the intensively controlled DCCT group than in EDC study group participants, who had a 47% rate of eye damage, a 17% rate of kidney damage, and a 14% rate of cardiovascular events.
According to lead author David M. Nathan, MD, “When intensive therapy, now the standard of care, is implemented early in the course of diabetes, most patients with Type 1 diabetes should be able to avoid the disastrous long-term complications that were so common in the past.”
For more information, read the article “Intensive Glucose Control Halves Complications of Longstanding Type 1 Diabetes,” or see the study’s abstract on the Web site of the Archives of Internal Medicine.
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