This article is from the WebMD News Archive
Tight Control Cuts Diabetes Heart Harm
Intensive Insulin Halves Heart Disease, Death in Type 1 Diabetes
Dec. 21, 2005 -- Tight blood sugar control with insulin slashes the risk of heart disease for people with type 1 diabetes in half, new research shows.
Two-thirds of people with diabetes die of heart attack or stroke. The risk of heart disease is 10 times higher in people with type 1 diabetes than in those without diabetes.
But a landmark study shows that by keeping their blood sugar under tight control, people with type 1 diabetes can reduce their risk of heart attack, stroke, and death from heart disease by 57%. Saul Genuth, MD, of Case Western Reserve University, chaired the study.
"We see a greater reduction in [heart attack, stroke, and death] from intensive blood glucose control than from drugs that lower blood pressure and cholesterol," Genuth says, in a news release. "This therapy should begin as early as possible and be maintained as long as possible."
It's likely that tight blood-sugar control will help people with type 2 diabetes, too. But proof that the benefits outweigh the risks won't arrive until a study of such patients is finished in 2009. Nevertheless, the current report -- in the Dec. 22 issue of the New England Journal of Medicine -- powerfully links high blood sugar to heart disease.
Long-Lasting Effects
Beginning in 1983, Genuth and colleagues signed up 1,441 type 1 diabetes patients. Half were assigned to what then was normal treatment: daily blood or urine testing for sugar levels, and one or two insulin shots a day.
The other half of patients got intensive treatment. They checked their blood-sugar levels at least four times a day, and took insulin injections three or more times a day or used an insulin pump. Their goal was to keep their HbA1c level -- a measure of average blood sugar over the past two to three months -- at less than 6%.
Over the 6.5-year study, the intensive-treatment group averaged an HbA1c level of 7.4%, while the normal-treatment group averaged 9.1%.
When the first phase of the study ended in 1993, normal-treatment patients were offered intensive treatment. Over the next decade, their HbA1c levels dropped. During that same time, the average HbA1c level for the original intensive-treatment group went up. Soon, both groups had the same HbA1c level.
Nevertheless, the effects of intensive treatment lingered. Even though the original intensive treatment group let their HbA1c levels rise well above the level of 7% recommended by the American Diabetes Association, they still had half the heart risk of the original normal-treatment group.
"One can only imagine what the reduction in the risk of [heart] disease events would have been had the intensively treated group ... had a greater difference in [blood-sugar] control," writes LSU researcher William t. Cefalu, MD, in an editorial accompanying the study.
Cefalu says he wonders whether it is time to lower the blood-sugar targets for children and adolescents as well as for adults. However, he notes that tight control is very hard to achieve.
"The medical community needs better means, different strategies, and a different mindset if we hope to improve and maintain [blood-sugar] control in patients with type 1 diabetes and minimize side effects," he writes. "Until the latter issue is addressed by the availability of new therapies and innovative approaches, the translation of research findings from a landmark study such as [this trial] may not alter clinical practice for many years. Given the complications and mortality attributed to cardiovascular disease among patients with type 1 diabetes, this delay would be most unfortunate."
© 2005 WebMD, Inc. All rights reserved.
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Is This Normal?
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Your level is currently NormalHigh (hyperglycemia).Low (hypoglycemia). |
If the level is below 70 and you are experiencing symptoms such as shaking, sweating or difficulty thinking, you will need to raise the number immediately. A quick solution is to eat a few pieces of hard candy or 1 tablespoon of sugar or honey. Recheck your numbers again in 15 minutes to see if the number has gone up. If not, repeat the steps above or call your doctor.
People who experience hypoglycemia several times in a week should call their health care provider. It's important to monitor your levels each day so you can make sure your numbers are within the range. If you are pregnant always consult with your health care provider.
If the level is below 70 and you are experiencing symptoms such as shaking, sweating or difficulty thinking, you will need to raise the number immediately. A quick solution is to eat a few pieces of hard candy or 1 tablespoon of sugar or honey. Recheck your numbers again in 15 minutes to see if the number has gone up. If not, repeat the steps above or call your doctor.
People who experience hypoglycemia several times in a week should call their health care provider. It's important to monitor your levels each day so you can make sure your numbers are within the range. If you are pregnant always consult with your health care provider.
Your blood sugar level is slightly high. You should call your health care provider and ask if laboratory tests to check for diabetes are needed. If you are pregnant always consult with your health care provider.
Congratulations on taking steps to manage your health.
However, it's important to continue to track your numbers so that you can make lifestyle changes if needed. If you are pregnant always consult with your physician.
Your level is currently normal. However, if you are concerned about diabetes speak with your physician. There may be other risk factors that increase your risk for diabetes.
Your level is high if this reading was taken before eating. Aim for 70-130 before meals and less than 180 two hours after meals.
Even if your number is high, it's not too late for you to take control of your health and lower your blood sugar.
One of the first steps is to monitor your levels each day. If you are pregnant always consult with your physician.
Your blood sugar level may be high, depending on when you last ate. If you have not eaten for at least 8 hours, your blood sugar should be less than 100. If you've eaten within the last 2 hours, your blood sugar should be less than 140. You should call your health care provider and ask if you need laboratory tests to check for diabetes. If you are pregnant always consult with your health care provider.
Blood sugars consistently above 180 warrant prompt medical attention.
Even if your number is high, it's not too late for you to take control of your health and lower your blood sugar.
One of the first steps is to monitor your levels each day. If you are pregnant always consult with your physician.
Your blood sugar level is high. You should call your health care provider and ask if laboratory tests to check for diabetes are needed. If you are pregnant always consult with your health care provider.
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