Diabetes

Clamping Down on Type 1 Diabetes

It was an impressive set of findings by all accounts. In a government-sponsored study that spanned 17 years, researchers found that tight blood sugar control could cut the risk of heart problems almost by half in people with type 1 diabetes.

Moreover, the intense therapy was given to young patients who were not at immediate risk, yet the protective effects followed them into adulthood. And the researchers were even holding back on the more potent insulin doses that some groups recommend.

"We can be very successful at controlling diabetes," says Dr. William Cefalu of the Pennington Biomedical Research Institute at Louisiana State University.

Now comes the hard part. While such strategies can clearly work, getting enough patients and doctors to follow intense treatment regimens has long stymied diabetes care.

"It takes a lot of effort," says Cefalu, who outlined his concerns in an editorial that accompanied the study. The findings and comment were recently published in the New England Journal of Medicine.

To better control type 1 diabetes, people may need as many as four shots of insulin a day, plus they have to pay considerable attention to their diet. There is also a lot of monitoring and adjustments needed to control fluctuations in blood sugar, which can require professional assistance. But visiting a local clinic does little good if the doctor doesn't have the staff or time to care for all your needs.

"If we think tight control of diabetes is important, then we need a different mind-set," Cefalu says.

How? First off, Cefalu says, is for everyone to realize the benefits of intensive therapy. The government-sponsored study followed more than 1,400 patients with type 1 diabetes. At the start of treatment, some patients were as young as 13 years of age, while the oldest were 40.

Half of the group was randomly assigned to intensive therapy, which consisted of three or more injections of insulin a day. They were told to monitor their blood sugar closely, keeping glucose levels around 70 to 120 milligrams per deciliter between meals and only allowing it to spike to 180 immediately after eating. The other patients were given one or two doses of insulin a day with no strict blood sugar goals.

After six-and-a-half years of taking part in the study, the patients went back to their own doctors and followed whatever care they wished. The vast majority stayed with intense therapy, while 94 percent of the normal treatment group attempted tighter blood sugar control.

It was a good move. Over the 17 years that patients were followed, stricter diabetes care reduced the risk of cardiovascular disease by 42 percent and heart attacks and stroke by 57 percent. "Intensive therapy should be implemented as early as possible in people with type 1 diabetes," the study authors concluded.

While this level of care may not always be available, especially when doctors are juggling dozens of patients at a time, Cefalu says that informed patients can make a difference.

"There is a great value in education," he says.