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Updated Wednesday, July 29, 2009 10:21 am TWN, By Julie Steenhuysen, Reuters

Early, intense therapy cuts type 1 diabetes risks

CHICAGO -- People with type 1 diabetes who can get their blood sugar to near-normal levels can cut their long-term risk of serious complications in half, U.S. researchers said on Monday. For people with type 1 diabetes — formerly called juvenile diabetes — intervening early with aggressive measures to control blood sugar worked far better than conventional care at reducing blindness, kidney failure, and heart disease in people who had lived with the disease for at least three decades.

“I think this is extremely exciting,” said Dr. Trevor Orchard of the University of Pittsburgh, who worked on the study published in the Archives of Internal Medicine.

“This halving virtually of the major complications ... I think is a very dramatic improvement and demonstrates that good intensive therapy from early on is very beneficial,” Orchard said in a telephone interview.

Type 1 diabetes represents about 10 percent of the 180 million cases of diabetes globally. It occurs when the immune system goes haywire and starts destroying insulin-producing cells in the pancreas needed to control blood sugar.

These patients typically need daily insulin to control their diabetes, which is a different disease from the far more common type 2 diabetes — a condition linked with obesity and lack of exercise.

Advanced insulin formulations, insulin pumps, and continuous glucose monitors, and better control of blood pressure and heart disease have vastly improved the outlook of people with type 1 diabetes, the team said. The total global market for treating both types of diabetes was US$25 billion in 2007.

The researchers compared overall rates of eye, kidney and cardiovascular complications in people with type 1 diabetes.

One group took insulin shots at least three times a day and took glucose readings at least four times a day with the goal of achieving a long-term average blood sugar or A1c reading of 7, which is in the normal range. A second group had conventional care, which was basically enough treatment to control diabetes symptoms. People in this group had an average A1c of 9.

The researchers followed the patients for 30 years, with the two groups staying on their treatment regimens from 1983 to 1989. Those who had been in the intensive group had about half the rate of eye damage compared to those assigned to conventional glucose control.

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