Diabetes Health Key: Blood-Sugar Control
Tight Control of Blood Sugar Keeps Arteries Unclogged, Reverses Early Kidney Trouble
WebMD News Archive
June 4, 2003 -- Tight control of blood sugar fights off heart disease -- the No. 1 killer in both type 1 and type 2 diabetes -- a new study suggests.
And avoiding high blood sugar has another benefit. It looks like the key to getting off a potentially deadly path toward kidney disease.
Both findings appear in the June 5 issue of The New England Journal of Medicine. Both focus on people with type 1 diabetes. But the authors say that the findings probably hold true for people with type 2 diabetes, too. So does Suzanne Gebhart, MD, director of the diabetes unit at Emory Clinic and clinical section chief in endocrinology at Emory University in Atlanta. Gebhart was not involved in the studies.
"The main point is the important effect of blood-sugar control on complications of diabetes, whether these are heart or kidney complications," Gebhart tells WebMD. "I think that is the overreaching broad view of both articles."
What's Good for Type 1 ...
Type 1 diabetes usually starts when something makes the immune system destroy the cells that make insulin, the hormone that controls blood-sugar levels. Type 2 diabetes is a more complex disease. It begins when obesity or other factors make the body resistant to insulin. Because type 2 diabetes is a combination of complex factors, it's harder to study than type 1 diabetes. However, general findings in studies of type 1 diabetes often end up applying to type 2 diabetes as well.
Ten years ago, a revolutionary study -- the Diabetes Control and Complications Trial or DCCT -- showed that intensive blood-sugar control in type 1 diabetes is crucial. The better the blood-sugar control, the fewer eye, nerve, and kidney complications. But because these patients were fairly young and the duration of the study was short, it's been hard to show an effect on heart disease.
High Blood Sugar = Heart Disease
David M. Nathan, MD, director of the Massachusetts General Hospital Diabetes Center in Boston, leads a study following up on type 1 diabetes patients from the DCCT. They took ultrasound measurements of the carotid artery -- the huge blood vessel running from the heart to the brain -- in 1,229 of these patients. Six-and-a-half years later, they took new measurements.
Some of the news was bad. Even though these patients were only in their mid-30s, they had serious thickening of the arteries -- an early warning of heart disease and stroke. The good news: Those who kept their blood sugar under tight control had significantly less thickening of the arteries.
"Nothing about this new finding changes what we ask patients to do. But it reinforces our recommendations for intensive management of blood sugar," Nathan tells WebMD. "Patients with diabetes usually do succumb to heart disease. Now we know that with tight control of blood sugar, not only can we prevent other diseases, but we also have a good chance cutting the risk of heart disease."