Early Glycemic Control Vital in Type 1 Diabetes

Benefits of intensive control appear to wane over time if A1C levels rise
By Monica Smith
HealthDay Reporter

THURSDAY, May 27 (HealthDay News) -- Intense glycemic control early on should be attempted for individuals with type 1 diabetes to reduce the risk of complications related to diabetes arising over time, according to research published in the May issue of Diabetes.

Neil H. White, M.D., of Washington University in St. Louis, and colleagues evaluated the progression of retinopathy in 1,055 adults and 156 adolescents for a decade after their completion of the Diabetes Control and Complications Trial (DCCT) to see how the persistence of the benefits of intensive therapy differs between adolescents and adults.

The researchers found HbA1c (A1C) similar between original intensive (INT) and conventional (CON) groups, and between former adolescents and adults. Ten years out, adults in the former INT group still had slower progression of diabetic retinopathy than those in the CON group, but in adolescents, the beneficial effect disappeared. The majority of the differences (79 percent) in the prolonged treatment effect between adults and adolescents after a decade were explained by differences in mean A1C during DCCT between adolescents and adults.

"Prior glycemic control during DCCT is vital for the persistence of the beneficial effects of INT therapy 10 years later. Lowering A1C to as close to normal as safely possible without severe hypoglycemia and starting as early as possible should be attempted for all subjects with type 1 diabetes. These results underscore the importance of maintaining A1C at target values for as long as possible because the benefits of former INT treatment wane over time if A1C levels rise," the authors write.

Lifescan, Roche, Aventis, Eli Lilly, OmniPod, Can-Am, B-D, Animas, Medtronic, Minimed, Bayer and Omron provided free or discounted supplies and/or equipment for the research.

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