Intensive Glucose Control Curbs Mortality in Type 1 Diabetes

January 20, 2015 03:52 pm Chris Crawford

A study published this month brings good news for people who have type 1 diabetes: Those who control their blood glucose intensively are likely to live longer than those who do not.

[Finger prick with glucose meter]

The study,(jama.jamanetwork.com) published online Jan. 6 in the Journal of the American Medical Association, found that tight control of the condition for the first seven years after diagnosis was associated with a 33 percent reduction in deaths compared to conventional control.

Of the 29.1 million people in the United States who had diabetes in 2012, 5 percent had type 1 disease, according to the CDC's 2014 National Diabetes Statistics Report.(www.cdc.gov)

Study Overview, Limitations

The Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Control and Complications (EDIC) Research Group oversaw the study and analyzed the collected data. After the end of the DCCT (1983-1993), researchers followed up with participants in an observational study conducted at 27 clinical centers that ended Dec. 31, 2012.

The more than 1,400 otherwise-healthy participants with diabetes were between ages 13 and 39 at baseline and had had the disease for one to 15 years with no or early microvascular complications and no hypertension, pre-existing cardiovascular disease or other potentially life-threatening diseases.

Story highlights
  • A recent study in the Journal of the American Medical Association found a 33 percent reduction in deaths among patients with type 1 diabetes who intensively controlled their blood glucose for the first seven years after diagnosis versus those who did not.
  • The Diabetes Control and Complications Trial/Epidemiology of Diabetes Control and Complications Research Group oversaw this study and analyzed its own collected data.
  • During the clinical trial, participants were randomly assigned to receive intensive therapy to help achieve glycemia as close to the nondiabetic range as safely possible.

During the clinical trial, participants were randomly assigned to receive intensive therapy to help achieve glycemic control as close to the nondiabetic range as was safely possible or conventional therapy. At the end of the DCCT, after a mean of 6.5 years, intensive therapy was taught and recommended to all participants, and diabetic care was returned to patients' personal physicians.

After a mean of 27 years of follow-up with these type 1 diabetes patients, the initial intensive diabetes therapy was associated with a modestly lower all-cause mortality rate when compared with conventional therapy.

As to limitations of the study, Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, told AAFP News that the absolute risk reduction was small at 1/1,000 patient years.

"There was not a large number of deaths, which limits the power of the study," she said. "The intensive control group had a significantly higher rate of nondiabetes-associated accidents and suicides, which is not explained. There was also a lack of diversity of the Diabetes Control and Complications Trial, as 96.5 percent of participants were white."

Frost pointed to another recent diabetes study(archinte.jamanetwork.com) published online Jan. 12 in JAMA Internal Medicine, which found that intensive control of type 2 diabetes in adults 65 and older was actually associated with increased mortality. She said the DCCT/EDIC study shows the same is not true for type 1 diabetes.

Intensive Blood Glucose Control Recommendations

Frost reminds family physicians that when treating patients with type 1 diabetes, it is important to find an insulin regimen that the patient is able to follow, optimizes glucose control and minimizes the risk of hypoglycemia.

"This can be challenging, so a team approach to care -- as one finds in a medical home -- is critical for these patients," said Frost. "They need to be educated about healthy and regular eating habits, encouraged to exercise, and informed about the risks and symptoms of hypoglycemia."

Because these patients' risk of cardiovascular and renal disease is high, all other risk factors for these conditions must be addressed, as well. "For example, an individual who has diabetes and also smokes tobacco should be aware of (his/her) dramatically increased risk of cardiovascular disease," said Frost. "They should be encouraged to quit and be offered assistance in this effort."


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