NIH. US: People with type 1 diabetes
who intensively control their blood glucose (blood sugar) early in
their disease are likely to live longer than those who do not,
according to research funded by the National Institutes of Health. The
findings are the latest results of the Diabetes Control and
Complications Trial (DCCT) and its follow-up, the Epidemiology of
Diabetes Control and Complications (EDIC) study. Results were published
online Jan. 6 in the Journal of the American Medical Association
“The outlook for people with type 1 diabetes continues to improve,” said
Catherine Cowie, Ph.D., of NIH’s National Institute of
Diabetes and Digestive and Kidney Diseases (NIDDK), the primary funder
of the study. “These results show that by tightly controlling their
blood glucose, people with type 1 diabetes can live longer.”
Type 1 diabetes typically occurs in younger people and
was formerly called juvenile-onset diabetes. In type 1 diabetes, the
body does not make insulin, and people with type 1 need to take daily
insulin to live.
Beginning in 1983, the DCCT/EDIC
study enrolled 1,441 people between ages 13 and 39 with recent-onset
type 1 diabetes. In the DCCT, half were assigned at random to intensive
blood glucose control designed to keep blood glucose as close to
normal as safely possible, and half to the conventional treatment at
the time. Both groups were similar in age. The DCCT ended in 1993 when
the intensive control group was found to have substantially less eye,
nerve and kidney disease. All participants were taught intensive blood
glucose control and followed during the ongoing EDIC. Blood glucose
control has been similar in both groups since DCCT ended.
Researchers found 107 deaths among DCCT/EDIC
participants, who were followed an average of 27 years from enrollment.
There were 64 deaths in the group that had initially received standard
treatment and 43 deaths in the intensive treatment group, a 33 percent
reduction in deaths. The most common causes of death – not all
necessarily related to diabetes – were cardiovascular diseases (22
percent), cancer (20 percent), acute diabetes complications – where
blood glucose became dangerously high or low (18 percent) – and
accidents/suicide (17 percent).
More people in the conventional treatment group than the
intervention group died from diabetic kidney disease (six vs. one). The
study also found that higher average glucose levels and increased
protein in the urine – a marker of diabetic kidney disease –were the
major risk factors for death.
“These results build on earlier studies, which suggested
that increased protein in the urine largely accounts for shorter
lifespans for people with type 1 diabetes,” said the study’s lead
author, Trevor Orchard, M.D., a professor at the University of
Pittsburgh Graduate School of Public Health. “These results further
emphasize the importance of good early glucose control, as this reduces
the risk for increased protein in the urine in general, as well as
diabetic kidney disease.”
Since the 1993 publication of the findings, the DCCT
intensive treatment has become standard practice for type 1 diabetes.
The new findings show that reductions in diabetes complications
resulting from tight glucose control translate into longer lifespans.
“Thanks to the findings over the years from the landmark
DCCT/EDIC study, millions of people with diabetes may prevent or delay
debilitating and often fatal complications from the disease,” said
NIDDK Director Griffin P. Rodgers, M.D. “NIH’s mission is to help
improve lives through biomedical research. These kinds of results
provide hard evidence that what we do helps people live longer,
healthier lives.”
Diabetes affects more than 29 million Americans, most of
whom have type 2 diabetes, often associated with overweight or obesity.
Another NIH study
found that in older adults with longstanding type 2 diabetes and high
cardiovascular disease risk, very intensive glucose control to near
normal levels actually increased mortality. In contrast, the DCCT/EDIC
studied intensive glucose control in younger people with type 1
diabetes earlier in the course of their disease and found intensive
control had a prolonged benefit in reducing mortality. Find more
information on diabetes at www.diabetes.niddk.nih.gov.
The NIH has supported the DCCT/EDIC over the past 31
years, currently under grants U01DK094176 and U01DK094157. The DCCT is
registered as NCT00360815 and EDIC is registered as NCT00360893 in Clinicaltrials.gov.
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