Just to be clear, I don’t think this means we can start slackin’. It means that the hard work is indeed worth it!
yeah, I saw this, too. Honestly, I felt like crying with relief.
Here’s the meat of the article which resides behind a register-wall:
In the DCCT conventional treatment group, the cumulative incidences after 30 years of diabetes were 50% for proliferative retinopathy, 25% for nephropathy, and 14% for cardiovascular disease. In the EDC cohort, the corresponding rates were 47%, 17%, and 14%, respectively. In contrast, cumulative incidences of these complications were markedly lower in the DCCT intensive therapy group (21%, 9%, and 9%), and fewer than 1% had blindness, needed kidney replacement, or underwent amputation because of diabetes during the same time frame.
“The frequencies of serious complications in patients with T1DM, especially when treated intensively, are lower than that reported historically,” the study authors write.
Limitations of this study include different methods of determining and defining complications, hindering precise historical comparisons. In addition, the EDC population had an earlier onset of diabetes.
“While the results of the DCCT/EDIC conventional therapy and of the Pittsburgh Epidemiology of Diabetes Complications study supply clinicians with a realistic description of clinical outcomes that they can discuss with their patients who have had their type 1 diabetes mellitus in the past 25 years, the intensive treatment group results provide a view of what patients with type 1 diabetes mellitus can expect in the future,” the study authors conclude. “Intensive therapy, now the standard of care, should result in more than 50 percent reduction in the rates of complications over time, with implementation early in the course of diabetes providing the most powerful salutary effect.”
And here’s a link to the abstract at the ncbi site:
Good news for those of us on strict BG control!
So right, Scott!
More on what “intensive control” of type 1 means …
I so wish for a clear answer: “If I get and keep my A1C at __%, I will avoid complications.”
Unfortunately, there is no way to state a specific A1C target for a population.
The intensively treated DCCT group was treated to a goal of less than 6%. However, less than 5% of the intensively treated participants achieved this goal during the trial (with lots of help). The median A1C of the intensively controlled group was 7.2%. (Diabetes mellitus, LeRoith et al).
So, should we aim for 7.2%? Well, probably yes if you’re currently higher. But half of the intensively controlled group achieved less than 7.2%. So lower than 7.2% is probably better. But, achieving that is NOT easy in real life (compared to support of a clinical trial) and, of course, hypoglycemia increased with the lower A1Cs.
That’s why, for now, groups such as the American Diabetes Association have broad goals: Under 7% and as close to normal (under 6%) as you and your health care provider decide is best for you.
The same A1C won’t yield the same complications results (or, as we hope, lack thereof) for two different people because genetic and environmental factors also affect the outcomes.
In other words, your A1C target is your target. My target may not be right for you. But we should always encourage each other to safely work on tighter control!
I might disagree a little with an A1c being the target, here’s why. I had an A1c of 6.3 in March of this year, yet was experiencing swings between 40 and 300 several times a week. I do not believe that is anyone’s idea of control. As some have recently suggested, I think it is better to have a lower standard deviation, ie get rid of those wild swings and try to keep the numbers as level as possible.
The problem I have with an A1c is that it tends to be an average. Average a really bad low number with a really bad high number and you get a really great number right in the middle that is totally meaningless. I would take a 7.2 where I had eliminated the wild swings over that 6.3 any day.
But that is just my humble, yet correct, opinion… /wink
oh and I just realized that “snikees” should probable be spelled “schnikees”
I agree (that you’re correct, most of the time, but humble? :-). Smooth and steady is the way to go, especially if you’re trying to live a productive and enjoyable life.
Until we’re all wearing CGMs, however, there’s no good way to see if we’re smooth and steady. Even 6-10 blood glucose fingerpricks a day won’t reveal all the ups and downs.
That darn A1C “average” is currently our best indicator. And, other key health markers: healthy blood pressure (a biggie for microvascular protection) and healthy blood lipids.
I just hope my genetics are extra good …
I am not sure that this will be true in the future since the new insulins do not contain C-peptides as did the animal ones.
Seeing is believing. For me CGMs are the coming standard for bg control. Like the switch from urine strips to bg strips. After having experienced the difference I hope I never have to switch back.
What are the longterm DRAWBACKS to “IDDM”… ? There was a SERIOUS problem attached w/ attempting far tighter control,(IDDM) c. 30% about one in three of us required external-outside assistance for the lows that intense management caused. Wonder where things stand with those figures today?
I wonder when this IDDM cycle will turn the other way? Will we ever hear ok, stop pushing so hard for tight control because such studies show it causes us real problems attempting it (eg lows, bounces, etc.)?
I haven’t been on an animal insulin since the early 1980’s, none of the human/analogs have ever contained C-Peptides to the best of my knowledge, but that is an interesting question. At the time the DCCT was done, were participants on human or animal insulins? was that tracked among the factors considered?
I guess for me the tighter control has led me to know more about how my body reacts to certain things and gives me more knowledge to be able to avoid hypo-events. Every event that I’ve had recently, I’ve been able to look back and see where I jacked something up. Now the times when sugars just seem to run high for no reason… lol, still a lot to learn
LOL, it’s not so much wearing the dang CGMS as it is having one that is really, truly reliable.
And yes I am humble… damn proud of it too!
Sorry to add the following (tinged with rancour ;-)):
I feel rather blasé reading press releases like this because for all the fine words it takes years (decades, even) for things to actually filter through to the patient. Insulin pumps and CGM are a long way off from general use in the UK - they’re castles in the sky. Carb counting (the DAFNE course - Dose Adjustment For Normal Eating) has only got off the ground in recent years and even this is not universally available (and where it is available, there are waiting lists to contend with).
So, like Helmut says, I’ll believe it when I see it.
I agree with you Scott. Caleb had a “great” A1C at our last visit that actually put a frown on my face. I just knew it was too low. Those dang swings average out and give the wrong impression sometimes. I believe that is the case with Caleb. I’m actually hoping for a slightly higher A1C this month. Standard deviation is an important measure.