Intensive Control of Type 1 Diabetes Helps Kidneys:
SATURDAY, Nov. 12 (HealthDay News) -- People with type 1
diabetes who maintain tighter control of their blood sugar levels
help protect their kidneys from long-term damage, finds a new
Those treated early with more intensive diabetes management
halved their risk of a kidney complication called impaired
glomerular filtration rate (GFR), the researchers said. An impaired
GFR can lead to end-stage renal disease, the most serious kidney
complication associated with diabetes.
"Our study shows that impaired GFR can be prevented in type 1 diabetes. This kidney complication that leads to end-stage renal disease doesn't have to happen," said the study's lead author, Dr. Ian de Boer, an assistant professor of medicine at the University of Washington in Seattle.
Results of the study are scheduled to be presented Saturday at
the American Society of Nephrology's annual meeting in Philadelphia
and published online simultaneously in the
New England Journal of Medicine.
Type 1 diabetes is an autoimmune disease that occurs when the
body's immune system mistakenly attacks and destroys healthy cells
in the pancreas that produce insulin. Insulin is a hormone involved
in the metabolism of carbohydrates, including sugar.
Because their insulin-producing cells have been destroyed,
people with type 1 diabetes must inject insulin to survive. If they
use too little insulin, they'll have high blood sugar levels, which
puts them at risk of long-term complications. But, too much insulin
increases the risk of low blood sugar levels, which can be
Kidney disease is a potential long-term complication of both
type 1 and type 2 diabetes. High blood sugar levels cause "cell
level toxicity and death that results in the loss of the filtering
units in the kidney that are replaced with scar tissue," explained
He and his colleagues reviewed data from the Diabetes Control
and Complications Trial (DCCT) and the Epidemiology of Diabetes
Interventions and Complications (EDIC) study. The DCCT included
more than 1,400 people with type 1 diabetes who were randomly
assigned to receive either intensive diabetes management or
conventional diabetes therapy at the time (1980s). The average time
since diagnosis with diabetes was about six years when the study
Intensive management was aimed at lowering hemoglobin A1C levels
(HbA1C) to less than 6.05 percent. HbA1C is a long-term (about two
to three months) measurement of blood sugar levels, and levels
below 6.05 percent are similar to levels for people who don't have
diabetes. Lower numbers generally translate into a lower risk of
The DCCT lasted for 6.5 years, and the EDIC trial is an
observational study that has followed the health of 1,375
participants since the DCCT ended. EDIC currently has 16 years of
During the DCCT, people in the intensive management group
averaged an HbA1C of 7.3, while the conventional group had an HbA1C
average of 9.1 percent. During EDIC, both groups had HbA1Cs around
8 percent, according to de Boer.
The current analysis looked specifically at the glomerular
filtration rate, which is a measure of how well kidneys
The researchers found that 24 people in the intensive therapy
group developed an impaired GFR, compared with 46 people in the
conventional therapy group.
"That's a risk reduction of 50 percent," said de Boer.
The risk of end-stage renal disease in the intensive therapy
group was also half that of the conventional therapy group -- eight
people versus 16.
"Getting good glucose control up front in the disease course provides benefits immediately and in preventing complications for years to come," de Boer said. "The longer you're able to maintain good glucose control, the more benefit you're likely to derive."
"The good news is that even in the control group, the incidence of renal failure is much lower than we used to see, and there's a further 50 percent reduction in the intensive group," said Dr. Joel Zonszein, director of the Clinical Diabetes Center at the Montefiore Medical Center in New York City.
"Very aggressive treatment early on can make a very big difference in renal function 20 years later," he added.
Learn more about type 1 diabetes and its management from the
Juvenile Diabetes Research Foundation.
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