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Study reports dramatic decline in complications

Discussion in 'Parents of Children with Type 1' started by Jeff, Jul 28, 2009.

  1. Jeff

    Jeff Founder, CWD

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    Modern-Day Clinical Course of Type 1 Diabetes Mellitus After 30 Years' Duration
    Arch Intern Med. 2009;169(14):1307-1316.
    http://archinte.ama-assn.org/cgi/content/short/169/14/1307

    This study showed that intensive control reduces the incidence of proliferative retinopathy, nephropathy, and cardiovascular disease signficantly compared with non-intensive control. DCCT incidence of these complications were 50%, 25%, and 14% after 30 years. In the intensively treated group, however, the rates were 21%, 9%, and 9%, and less than 1% went blind, needed a kidney transplant, or lost a limb.

    These results, while not where we want them (0% across the board), are exceptionally positive and reinforce the importance and benefit of intensive management.
     
  2. Heather(CA)

    Heather(CA) Approved members

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    So by intensive control they mean several shots a day or a pump? Is that right? Thanks for the info by the way:cwds:
     
  3. Pavlos

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    That is very encouraging news, Jeff :cwds:

    My belated thanks for urging me to shift from Regular/NPH (which is unfortunately the standard procedure here in Greece) to MDI back in Nov '07 when my daughter was dx'd :)
     
  4. Christopher

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    The way I read it, they are saying "conventional" therapy is 1 to 2 shots a day and "intensive" therapy is 3 or more shots a day or an insulin pump. However, they don't say what insulins they are using. Is conventional NPH and intensive Humalog? Is it all Humalog and they are only giving 1 to 2 shots a day of Humalog? Regardless, to me these kinds of studies are a no brainer. Obviously, if you are trying to keep blood glucose levels as close to normal as possible, and are using insulin on a regular, methodical basis, your chances for future complications should be lower.
     
    Last edited: Jul 28, 2009
  5. iluvmhp

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    Interesting. Thank you for sharing this Jeff. I am off to share this with my mother, who doesnt understand why we do such intensive therapy these days. My father was t1 and of course took 2 injections per day and barely paid attention to his d. He was fortunate and did not have complications. She feels the pump and constant management is "overkill" and is a lot of work. This study will be great to share. Thank you again.
     
  6. Becky Stevens mom

    Becky Stevens mom Approved members

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    This is very interesting, and encouraging. Ive always taken intensive therapy to mean pump or MDI with basal of lantus or levemir and boluses of humolog/novolog/apidra which is supposed to be similar to what the pancreas does in a non d person.
     
  7. hawkeyegirl

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    Yes, the "intensive" group received at least 3 shots a day of rapid-acting, checked BG at least 4 times a day, and had a1Cs around 7. The non-intensive group had 1-2 injections a day and a1Cs around 9.

    So for me it's a bit...duh. "Intensive" therapy (I keep putting that in quotes, as 3 shots a day and checking BG 4 times a day doesn't seem very intensive to me) leads to lower a1Cs and lower risk of complications. Who woulda thunk? :rolleyes:
     
  8. Heather(CA)

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    Yea, not to mention the fact that we now have testers to carry around. That along with MDI and pumps should have a HUGE affect.:D
     
  9. frizzyrazzy

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    I think one good thing (of many) to take from this study is that we all are doing FAR more than was done 30 years ago, and much more than was done during the DCCT. So the outcome for our kids is going to be positively wonderful. This doesn't seem to point to "low at all costs" or "non-diabetic a1c is the gold standard" though. At least that's not what I'm taking from this study.
     
  10. Darryl

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    Actually, if you read the DCCT and EDIC studies, there was more to intensive control than
    just doing the prescribed number of tests and corrections each day.

    A1C goal of the intensive group was 6.05% max (they did not always meet this goal, but
    had much lower A1C's than the standard treatment group). To try to achive an A1C of 6%
    without a CGM, the participants endured frequent hypo's, all to test a theory that maintaining
    a low A1C reduced complication risk. It was, given that CGM's were not available at the time,
    indeed a "low at all costs" study, with the result that low A1C greatly reduced complications.

    And the conclusion of the DCCT study group was, after reviewing 20 years of data, that BG
    should be kept "as close to a non-diabetic range as safely possible".

    The main difference now is that we can shoot for A1C's in the 5%-6% range with minimal
    risk of hypos, and that using a CGM, we can control variability around the clock if we want to.
     
  11. frizzyrazzy

    frizzyrazzy Approved members

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    actually I was trying to pat the parents here on the back for the good work that they already do when far too often they're beat up for not doing enough, for not trying hard enough.
     
  12. momandwifeoftype1s

    momandwifeoftype1s Approved members

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    It's funny how several of us can read the same article and have such different reactions. I took it to mean that with today's advances, our kids are less likely to have diabetes related complications. I'm happy that every year, doctors learn more about how to make our kids as healthy as possible. :)
     

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