Tight Blood Sugar Control Wards Off Diabetes Complications

Source: Tufts University
December 12, 2003

Keeping blood sugar levels under tight control will lessen the chances of developing or slow the progression of diabetes complications such as eye, kidney, and nerve damage and heart disease. New data from the Epidemiology of Diabetes Interventions and Complications Study (EDIC) shows that intensive blood sugar control can delay the progression of diabetes-related kidney disease for several years after supervised intensive treatment has ended. The findings are published in the Journal of the American Medical Association.

The Diabetes Control and Complications Trial

The Diabetes Control and Complications Trial (DCCT) included teenagers and adults with type 1 diabetes, who were otherwise in good health. Half of them were assigned to receive "intensive" treatment, which involved frequent blood sugar testing and insulin injections - the goal being to maintain blood sugar as close to normal levels as possible - and monthly visits to a health care team. The other half received "conventional" diabetes treatment, which meant less frequent monitoring with the goal of remaining free of high or low blood sugar symptoms.

At the end of the 6½ year study, those in the intensive treatment group had reduced the development and progression of eye, nerve and kidney complications more effectively than conventional treatment. The intensive intervention was stopped, and all participants were encouraged to either continue with or initiate "intensive" treatment on their own.

At that point a new study (EDIC) was started, which continued to follow 1349 of the DCCT volunteers. For the next 8 years, researchers continued to assess their blood sugar levels, kidney function, and blood pressure, while the participants received diabetes care from their physicians. Those who received "intensive" treatment were compared with those who received "conventional" treatment to determine the long term effects - if any - of intensive diabetes control during the DCCT trial on kidney health.

The benefits continue

The EDIC researchers found that the volunteers' HbA1C levels - an average of blood sugar levels from the prior 3 months - drew closely together. However, the original members of the intensive treatment group were about 60% less likely to develop microalbuminuria - small amount of albumin, a blood protein, appearing in urine - which is an early marker for kidney disease. Less than 2% of them went on to develop clinical albuminuria, the more advanced stage of the disease, compared with almost 10% of those who received "conventional" treatment during the DCCT. Fewer of those from the "intensive" group developed high blood pressure, which is also a factor in the development and acceleration of kidney failure.

Intensive therapy at home

The investigators conclude that people with diabetes should institute and follow intensive treatment as early as possible to minimize the risk of developing kidney disease. While these results indicate that the benefits outlast the intensive treatment period, further study is needed to determine how long the effects remain. Besides frequent blood sugar testing and insulin injections - or the use of an insulin pump - other components of intensive therapy are a diet and exercise plan with regular instruction and support, monthly health care visits, and interaction with an integrated healthcare team.

Source

• Sustained effect of intensive treatment of type 1 diabetes mellitus on development and progression of diabetic nephropathy: The Epidemiology of Diabetes Interventions and Complications (EDIC) Study.  The Writing Team for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group., JAMA, 2003, vol. 290, pp. 2159--2167

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