One Diabetes Treatment May Extend Patients' Lives

Type 1 diabetes patients who have intensive therapy may live longer than those who receive conventional treatment

(RxWiki News) Not all diabetes treatments are created equal. One type of treatment may extend patients' lives.

In a study from around 20 years ago, researchers weighed two different approaches to treatment of patients with type 1 diabetes. They found that a more intensive approach involving more frequent insulin injections and close monitoring was more effective than conventional treatment at reducing eye, nerve and kidney complications.

Now, decades after that trial ended, researchers have studied the death rates between the two groups in the past study. They found that the overall risk of dying in the intensive treatment group was lower than in the conventional group.

Trevor J. Orchard, MD, of the University of Pittsburgh Graduate School of Public Health, and colleagues followed up with type 1 diabetes patients who had participated in the Diabetes Control and Complications Trial (DCCT) from 1983 to 1993. This study looked at death rates among these patients as of the end of 2012.

“The outlook for people with type 1 diabetes continues to improve,” said Catherine Cowie, PhD, of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), in a press release. “These results show that by tightly controlling their blood glucose, people with type 1 diabetes can live longer.”

A total of 1,441 healthy patients with type 1 diabetes participated in the initial trial. Some received intensive therapy, and others received what was considered conventional treatment at the time.

Conventional therapy consisted of one or two daily injections of insulin. Intensive treatment included the administration of insulin three or more times daily by injection or an external pump. For the intensive patients, dosage was adjusted according to the results of self-monitoring of blood glucose (blood sugar).

When the initial trial ended in 1993, researchers observed that the patients receiving an average of 6.5 years of intensive treatment had a lower rate of eye, nerve and kidney disease. Since that time, the DCCT intensive approach has become the standard for type 1 diabetes treatment.

From the end of the study forward, all patients were taught intensive blood sugar control. Blood sugar control remained similar in these two groups.

Looking at death rates in the two groups as of the end of 2012, Dr. Orchard and team found that 64 patients (8.8 percent) had died in the conventional treatment group and 43 (6 percent) had died in the intensive therapy population.

Dr. Orchard and colleagues noted that higher average blood sugar levels and increased protein in the urine (a marker for kidney disease) were major risk factors.

“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,” Dr. Orchard said in a press 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.”

Type 1 diabetes is often diagnosed when people are children and young adults. With this condition, the pancreas produces little or no insulin. Insulin is a hormone that helps cells use glucose for energy. Without sufficient insulin, glucose can build up in the bloodstream and damage the body.

This study was published Jan. 6 in JAMA.

The NIDDK funded this research. Dr. Orchard and team disclosed no conflicts of interest.

Review Date: 
January 6, 2015