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Thursday, 22 January 2015

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.

The study,( 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.(

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.

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.

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."

How to achieve a normal A1c and cut the risks of hypoglycemia with a LowCarb diet


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