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(Ivanhoe Newswire) -- The outlook for people with long-standing type 1 diabetes has greatly improved in the past 20 years due to a better understanding of the importance of intensive glucose control as well as advances in insulin formulations, insulin delivery, glucose monitoring and the treatment of cardiovascular risk factors, concludes a study which updates information on the clinical course of type 1 diabetes.
Formerly called juvenile-onset diabetes or insulin-dependent diabetes, type 1 diabetes develops when the body's immune system destroys the pancreatic beta cells that make the hormone insulin that regulates blood glucose. This form of diabetes usually arises in children and young adults, though it can occur at any age. Management involves keeping blood glucose levels as close to normal as possible with three or more insulin injections a day or treatment with an insulin pump, careful monitoring of glucose, and close attention to diet and exercise. Of the nearly 24 million people in the U.S. who have diabetes, in adults type 1 diabetes accounts for 5 to 10 percent of diagnosed cases.
"The demonstration that near-normal glucose control substantially lowers microvascular and cardiovascular complications has heralded a new era of type 1 diabetes care," lead author David M. Nathan, M.D., of Massachusetts General Hospital, is quoted as saying. Dr. Nathan is also co-chair of the landmark Diabetes Control and Complications Trial (DCCT) and its follow-up study, the Epidemiology of Diabetes Interventions and Complications (EDIC).
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"The remarkable improvement in long-term outcomes achieved with intensive glucose control, said Nathan, should encourage clinicians and patients alike to implement intensive therapy as early in the course of type 1 diabetes as possible."
The study compared overall rates of eye, kidney and cardiovascular complications in three groups of people diagnosed with type 1 diabetes an average of 30 years earlier. Two groups consisted of DCCT/EDIC participants randomly assigned to intensive glucose control or to conventional control. The third group was a subset of patients in the Pittsburgh Epidemiology of Diabetes Complications (EDC) study, who were matched to the other participants by age, duration of diabetes and degree of eye damage.
After 30 years of diabetes, participants randomly assigned to intensive glucose control had about half the rate of eye damage compared to those assigned to conventional glucose control. They also had lower rates of kidney damage and cardiovascular disease.
"Better treatment of blood pressure and cholesterol is also helping to reduce complication rates," Trevor Orchard, M.D., of the University of Pittsburgh, who heads the EDC study was quoted as saying.
"After 30 years of diabetes, fewer than 1 percent of those receiving intensive glucose control ... significantly impaired vision, kidney failure or needed a limb amputation due to diabetes," Saul Genuth, M.D., of Case Western University, who co-chairs the EDIC study, was quoted as saying. "Tight control is difficult to achieve and maintain, but its benefits have changed the course of diabetes."
"When intensive therapy, now the standard of care, is implemented early in the course of diabetes, said Nathan, most patients with type 1 diabetes should be able to avoid the disastrous long-term complications that were so common in the past."
SOURCE: Archives of Internal Medicine, July 27, 2009
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