Intensive Type 1 Diabetes Treatment Best

Benefits of Intensive Type 1 Diabetes Therapy Persist

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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 U.S.

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 function.

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.

Continued

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."

WebMD Health News Reviewed by Brunilda Nazario, MD on October 21, 2003

Sources

SOURCES: Nathan, D. The Journal of the American Medical Association, Oct. 22-29, 2003; vol 290: pp 2159-2167. WebMD Medical Reference from Healthwise: "Type 1 Diabetes."

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