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Intensive blood glucose control decreased type 1 diabetes mortality
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People who intensively control their blood glucose soon after receiving a type 1 diabetes diagnosis are likely to live longer than those who do not, according to recent study findings published in JAMA.
“These results build on earlier studies, which suggested that increased protein in the urine largely accounts for shorter lifespans for people with type 1 diabetes,” Trevor Orchard, MD, professor at the University of Pittsburgh Graduate School of Public Health, said in the release. “These results 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 diabetic kidney disease.”
Trevor Orchard
Orchard and colleagues conducted an observational, long-term follow-up study on the Diabetes Control and Complications Trial (DCCT; 1983-1993) cohort to determine whether mortality differed between people with type 1 diabetes receiving intensive therapy (n=711) and conventional therapy (n=730) for a mean of 6.5 years. Follow-up was conducted as part of the Epidemiology of Diabetes Interventions and Complication (EDIC) study until Dec. 31, 2012.
Overall, there were 107 deaths. The intensive treatment group had fewer deaths (6%) compared with the conventional group (8.8%; P=.045).
Cardiovascular events were the most common cause of death (22.4%), followed by cancer (19.6%), acute diabetes complications (17.8%), and accidents or suicide (16.8%). Compared with the conventional group, there were fewer deaths from diabetic renal, CV and cancer causes among the intensive group.
The risk for mortality was associated with albuminuria and end-stage renal disease during the study and was higher among participants with any albuminuria (albumin excretion rate ≥40 mg/24 hours) compared with those with a normal history (HR=2.2; 95% CI, 1.46-3.31). Participants with renal insufficiency had a higher risk for mortality vs. those without (HR=8.51; 95% CI, 4.45-16.27).
Higher mean HbA1c levels also were associated with a higher risk for mortality (P<.001).
“We can now confidently tell doctors and patients that good, early control of blood glucose greatly reduces any risk for mortality in people with type 1 diabetes, usually diagnosed in children and young adults,” Orchard said. “These results also remove any lingering concern that intensive therapy may lead to increased mortality.”
Disclosure: The researchers report no relevant financial disclosures.
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