Tight glucose control best for type 1 diabetes

Intensive therapy early on is the best course of action
Intensive therapy early on is the best course of action

You can assure patients with type 1 diabetes that keeping their glucose levels as close to normal as possible—particularly early on—is the best course of action.

This encouragement comes from the landmark Diabetes Control and Complications Trial (DCCT) and the subsequent Epidemiology of Diabetes Interventions and Complications (EDIC) study. The DCCT/EDIC team recently reported on the long-term clinical course of type 1 diabetes in the age of intensive therapy (Arch Intern Med. 2009; 169:1307-1316).

The DCCT ran from 1983 through 1994, delivering conventional treatment or intensive therapy to more than 1,400 people with type 1 diabetes. A total of 688 conventionally treated patients and 687 from the intensive arm participated in the EDIC follow-up study, which included annual exams to measure diabetes complications. These individuals were followed for an average of 18.5 years.

After a diabetes duration of 30 years, the cumulative incidences of proliferative retinopathy, ne- phropathy, and cardiovascular disease were 50%, 25%, and 14%, respectively, in the DCCT/EDIC conventional treatment group, but only 21%, 9%, and 9% in the intensive treatment group. These results reflect “the powerful effect of intensive therapy over time,” according to the researchers, who conclude that “intensive therapy, now the standard of care, should result in more than 50% reduction in the rates of complications over time, with implementation early in the course of diabetes providing the most powerful salutary effect.”

Another study revealed that type 2 diabetics who took the oral antidiabetes drug metformin had a 60% lower risk of pancreatic cancer than people who did not use this agent (Gastroenterology. 2009;137:412-415). However, the investigators also learned that insulin and insulin secretagogues may be associated with an increased risk for this cancer.

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