Intensive Glycemic Control Pays
Interest Before and After Retirement
According to a new analysis from DCCT,
intensive glycemic control is associated with
reduced coronary calcification, a marker of atherosclerosis,
years later -- even if control has become less
intense in the interim.
John Lachin, ScD, professor of biostatistics
at George Washington University in Washington,
D.C., United States, and principal investigator
presented the findings on behalf of the Diabetes
Control and Complications Trial/Epidemiology of
Diabetes Interventions and Complications (DCCT/EDIC)
Study Group at the 63rd Scientific Sessions of
the American Diabetes Association.
Specifically, bringing blood glucose levels as
close to target levels as possible for an average
of 6.52 years yields reduced atherosclerosis risk
even after 8 years of less effective control,
compared with never achieving tight control, Dr.
Lachin said.
The DCCT, which began nearly 20 years ago, showed
that intensive control yielded an average hemoglobin
A1c level of 7%, compared with 9% for conventional
control. It also showed that reduced HbA1c levels
were associated with a 39% to 76% reduction in
risk of microvascular complications, including
retinopathy, neuropathy, and nephropathy.
About 95% of the DCCT participants subsequently
enrolled in the EDIC observation study where they
were evaluated annually for 8 years.
Dr. Lachin said that interim EDIC results showed
that after DCCT ended and patients were turned
over to their own physicians, HbA1c levels of
the 2 treatment groups started to drift together,
until both the conventionally and intensively
treated groups had average HbA1c levels of close
to 8%, Dr. Lachin said.
Nevertheless, he reported that the patients in
the intensive-control arm now have significantly
less calcification in their coronary arteries
than those who were on conventional control.
His team used computed tomography to assess the
coronary arteries of 1,150 patients originally
enrolled in DCCT, who had diabetes for an average
of 21 years.
After adjusting for gender, attained age, scanning
site, baseline retinopathy, and smoking status,
people who were formerly in the conventional therapy
group were about 90% more likely to have a high
coronary calcification score -- defined as greater
than 200 Agatston units -- compared with those
on intensive therapy. And they were 52% more likely
to have a coronary calcification score greater
than 100 Agatston units, the study showed.
"Glycemia matters," Dr. Lachin said.
"It matters in the short term, and it matters
especially in the long term."
[Study title: Coronary Calcification in the Diabetes
Control and Complications Trial/Epidemiology of
Diabetes Interventions and Complications (DCCT/EDIC)
Cohort for the DCCT/EDIC Study Group. Abstract
652-P]
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FACT:
Nephropathy has no signs or symptoms in its early
stages. Signs and symptoms usually occur after
much damage has been done and include: Fluid buildup
or retention, sleeplessness and tiredness, vomiting,
weakness, hypertension, and extended period of
hyperglycemia. That is why a microalbumin test
should be done at diagnosis of Diabetes and also
Prediabetes..
