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Tight Management of Type 1 Diabetes Worth the Effort
Date:7/27/2009

rom the Pittsburgh Epidemiology of Diabetes Complications (EDC) study. The average time since the diagnosis of type 1 diabetes was 25 to 30 years.

At the time both of these studies started in the 1980s, conventional type 1 diabetes management was significantly different than it is today. Home blood glucose meters had only recently been introduced, and there were fewer options in insulin and insulin delivery at the time.

The DCCT trial was an intervention trial, and half of the volunteers were asked to take more frequent insulin and monitor their blood sugar levels more often with the goal of achieving a hemoglobin A1c (HbA1c) level of around 6 percent. The conventional group had levels of about 9 percent at the end of the study, while the intensive group had lowered their A1c levels to an average of 7.4 percent. Hemoglobin A1c is a test that measures blood sugar control over the past two to three months. A normal level for someone without diabetes is less than 6 percent. Forty-four percent of those in the intensive arm of the DCCT had HbA1c levels of less than 7 percent.

The EDC trial was simply an observational trial, and no intervention above normal management was given. Their average HbA1c levels at the end of the study were 7.8 percent.

After almost 30 years of having diabetes, the cumulative incidence of diabetic eye disease was 50 percent in the DCCT's conventional treatment group, 47 percent in the EDC group and 21 percent in the intensive-management group.

Diabetic kidney disease was present in 25 percent of those in the standard DCCT group, 17 percent in EDC and just 9 percent in the intensive DCCT group.

Heart disease occurred in 14 percent of the conventional group and EDC, and 9 percent in the intensively managed DCCT volunteers. However, it should be noted that the study participants were, on average, only in their 30s and 40s when these studies ended.

Both Nathan and Araneo said
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