Intensive Type 1 Diabetes Treatment Best
Benefits of Intensive Type 1 Diabetes Therapy Persist
Oct. 21, 2003 -- Intensive treatment of type 1 diabetes may
provide lasting benefits that reduce the risk of long-term complications from
the disease, a new study shows.
Researchers found the benefits of previous intensive-diabetes
therapy can last up to eight years. They also found that intensive therapy has
extended effects that may help delay or prevent the progression of
diabetes-related kidney and heart problems.
Type 1 diabetes is a lifelong disease that occurs when the
pancreas stops producing insulin because of an immune attack and destruction of
cells within the pancreas that produce insulin. It's much less common than type
2 diabetes and accounts for nearly 5% to 10% of all diabetes cases in the
Intensive Treatment, Lasting Benefits
The study, published in the Oct. 22-29 issue of The Journal
of the American Medical Association, looked at the long-term effects of
intensive vs. conventional treatment for type 1 diabetes on kidney
Kidney damage is a common complication of diabetes and is
thought to result from chronically high blood sugar levels that eventually
damage the kidney's ability to filter blood.
In the study, researchers followed 1,350 people with type 1
diabetes who participated in the Diabetes Control and Complications Trial
(DCCT) for eight years after the study.
The DCCT was a landmark study which tested whether the
complications of diabetes were related to elevations in blood glucose. Two
groups of patients were followed -- a conventional-treatment (also called
standard treatment) group and an intensive-therapy group. The
conventional-treatment group rceived insulin injections twice a day and gluocse
monitoring to prevent severe increases in sugars. The intensive-therapy group
recieved mutiple injections of insulin or were on the insulin pump. This group
monitored their sugars wth a goal to obtain as near normal sugars as possible.
That study showed that there was a 60% reduction in complications of diabetes
in the intensive-therapy group.
In this study, which followed the groups another eight years
after completion of the DCCT, researchers wanted to see the long-term effect of
intensive therapy on kidney function. During this part of the follow-up the
blood glucose levels were no longer substantially different between the two
original treatment groups.
They found that about twice as many new cases of
microalbuminuria (small amounts of protein in the urine, an early sign of
kidney damage) occurred in the group originally designed to follow conventional
treatment compared with those who originally received intensive treatment (16%
vs. 7%). Eight years later, those originally assigned to the intensive-therapy
group in the DCCT had the same 60% reduced risk of kidney complications.
The study also showed that fewer cases of high blood pressure
were reported eight years after intensive treatment compared with conventional
therapy (30% vs. 40%), and fewer patients that received intensive type 1
diabetes treatment required dialysis or a kidney transplant.
Researchers say it's the first time a study has demonstrated
clear benefits of intensive-diabetes treatment on the development of high blood
pressure, which also bodes well for reducing the risk of other long-term
complications commonly associated with diabetes.
"The current results affirm that intensive treatment of
type 1 diabetes should be initiated as early as is safely possible in order to
provide strong and durable protection from the development and progression of
diabetic [heart] disease," write the authors. "The protection initiated
by intensive treatment appears to outlast the intensive treatment itself,
although the duration of the effect remains to be seen."