Controlling Blood Glucose Extends Life for People with Diabetes
People with Type 1 diabetes who intensively control their blood glucose soon after diagnosis are likely to live longer than those who do not, according to a recent report led by a University of Pittsburgh Graduate School of Public Health investigator.
Data from a long-running trial and follow-up observational study showed a 33 percent reduction in deaths over the past several decades among participants who established early, good control of their blood glucose. The research was funded by the National Institutes of Health and included participants from 27 academic medical centers in the United States and Canada. The findings are detailed in the current issue of the Journal of the American Medical Association (JAMA).
“We can now confidently tell doctors and patients that good, early control of blood glucose greatly reduces any risk for early mortality in people with Type 1 diabetes, usually diagnosed in children and young adults,” said lead author Trevor Orchard, a professor of epidemiology at Pitt Public Health. “These results also remove any lingering concern that intensive therapy may lead to increased mortality.”
The long-running Diabetes Control and Complications Trial—and the subsequent Epidemiology of Diabetes Control and Complications observational study—are referred to as the DCCT/EDIC study. The results have significantly changed treatment protocols for Type 1 diabetes and have also improved the outlook for people with the condition over the past several decades, explained Griffin P. Rodgers, director of NIH’s National Institute of Diabetes and Digestive Kidney Diseases.
“Thanks to the findings over the years from the landmark DCCT/EDIC study, millions of people with diabetes may prevent or delay debilitating and often fatal complications from the disease,” Rodgers said.
Type 1 diabetes occurs when the body does not produce insulin, a hormone that is needed to convert sugar into energy. By regularly monitoring their blood glucose levels and adjusting doses of insulin accordingly, patients can work to keep their blood glucose in a normal range.
Beginning in 1983, the DCCT enrolled 1,441 volunteers between ages 13 and 39 with recent-onset Type 1 diabetes. Half of the participants were randomly assigned to intensive efforts to keep blood glucose—also known as blood sugar—as close to normal levels as possible. The other half were assigned to the conventional treatment at the time, which simply sought to keep blood glucose levels from getting so high or low that patients would show symptoms, such as blurred vision or shortness of breath.
The trial ended in 1993 when the intensive group was found to have less eye, nerve, and kidney disease. All participants were then taught the intensive blood glucose control techniques and early, good control of blood glucose was recommended for all people with Type 1 diabetes. The EDIC study was then launched to continue tracking the health of all the participants.
Since 1983, 107 trial participants have died, with 64 in the group that originally received standard treatment, compared with 43 in the intensive treatment group.
The most common causes of death were cardiovascular disease (22 percent), cancer (20 percent), and acute diabetes complications (18 percent), all of which were more common in the group that originally received conventional treatment. Accidents or suicide were the fourth most common cause of death at 17 percent, with nominally more deaths in the people assigned to the early intensive treatment.
Higher average glucose levels and increased protein in the urine—a marker of diabetic kidney disease—were the major risk factors for death.
“These results build on earlier studies that suggested that increased protein in the urine largely accounts for shorter lifespans for people with Type 1 diabetes,” Orchard said. “Our findings further emphasize the importance of good, early glucose control, as this reduces the risk for increased protein in the urine in general, as well as for diabetic kidney disease itself.”
While this study found an association between intensive blood glucose control and decreased mortality in people with Type 1 diabetes, Orchard and his colleagues noted that the results cannot be extended to people with Type 2 diabetes. Previous, unrelated studies have shown conflicting results for Type 2 diabetes.
Additional authors on the JAMA publication were researchers from The George Washington University, Harvard Medical School, the University of Toronto, and Cornell University Medical Center.
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On the Freedom Road
Follow a group of Pitt students on the Returning to the Roots of Civil Rights bus tour, a nine-day, 2,300-mile journey crisscrossing five states.
Day 1: The Awakening
Day 2: Deep Impressions
Day 3: Music, Montgomery, and More
Day 4: Looking Back, Looking Forward
Day 5: Learning to Remember
Day 6: The Mountaintop
Day 7: Slavery and Beyond
Day 8: Lessons to Bring Home
Day 9: Final Lessons