Issue 179 Item 3 Good Diabetes Control Benefits Last Many Years

In diabetics, intensive control of blood sugar levels seems to slow the progression of kidney disease many years after such control has ended, new research shows.

Started in 1981, the Diabetes Control and Complications Trial (DCCT) compared the benefits of intensive and conventional therapy in 1441 type 1 (i.e., insulin-dependent) diabetics. The intensive therapy consisted of at least three daily insulin injections with frequent sugar monitoring. In contrast, conventional therapy consisted of no more than two daily injections and one blood or urine sugar test.

The results from DCCT revealed that intensive therapy was better than conventional therapy at controlling sugar levels and at slowing the progression of kidney disease. After DCCT ended in 1989, patients in the conventional group were offered intensive therapy supervised by their own physicians, while those in the treatment group were encouraged to continue the intensive therapy.
The current study, known as the Epidemiology of Diabetes Interventions and Complications (EDIC) study, represents eight years of additional follow-up for former DCCT participants. The results are reported in the Journal of the American Medical Association.
Dr. David M. Nathan, from Massachusetts General Hospital stated that, "Over time, the glycemic levels of the former control group began to drop, while those of the former intervention group rose, so that during the EDIC study the levels in each group were no longer substantially different."

Interestingly, although each group now had similar levels, a kidney benefit was still seen in the former intensive therapy group, Nathan noted.

The new findings complement those reported in 2000, which showed that intensive therapy also provides a persistent reduction in the risk of diabetic eye disease.

In addition to slowing the progression of kidney disease, intensive therapy reduced the risk of high blood pressure, the authors point out.

"The take-home message is that early, intensive intervention is very important," Nathan emphasized. "The earlier that patients can intervene to (control blood sugar) the better effect they’re going to get and the better long-term outcomes they’re going to have." Journal of the American Medical Association, October 22/29, 2003.

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