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| Tight Glucose Control Cuts Heart Disease Risk in Half |
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 New research gives people with type 1
diabetes another reason to keep their blood sugar levels under
control: It could cut their risk of heart disease in
half.
Previous studies have linked tight blood sugar control
to lower risk of clogged arteries and eye, kidney and nerve disease,
said study author Dr. David Nathan, director of the Diabetes Center
at Massachusetts General Hospital. Now, he said, the new findings
"send a very important message" on the entire cardiovascular
front.
Still, "there are substantial numbers who are not
reaching the glucose levels that would benefit them," said Nathan,
who presented the study Sunday at the American Diabetes Association
annual meeting in San Diego.
As many as 1 million Americans
have type 1 diabetes, which typically strikes children and young
adults and stops the body from producing enough insulin to process
blood sugar. Type 2 diabetes is much more common, affecting perhaps
17 million Americans.
Nathan and his colleagues followed
1,441 volunteers with type 1 diabetes who were enrolled in a study
between 1983 and 1989. The patients were 13 to 39 years old when
they took part in the study, and the researchers wanted to see if
they developed heart disease as they got older, Nathan
said.
Some of the patients were told to intensively control
their diabetes to keep their hemoglobin A1c (HbA1c) levels as close
as possible to the normal value of 6 percent or less. (According to
the researchers, the levels indicate the level of sugar in the blood
over the past two to three months.)
To do so, the patients
had to closely monitor their blood sugar levels and give themselves
at least three insulin injections a day or use an insulin pump.
Normally, patients would have given themselves fewer
injections.
After about six years, researchers advised both
groups -- those who intensively controlled their diabetes and those
who didn't -- to carefully control their blood sugar levels. Over
time, the levels in both groups leveled off to about 8
percent.
Even so, the six years of being in the intensive
control group in the 1980s paid off for those patients. Of 1,375
volunteers who continued to provide information to researchers,
those who had intensively controlled their diabetes in the 1980s
were less than half as likely as the others to have had heart
attacks, strokes, angina, angioplasties or coronary bypass
operations.
In general, people with type 1 diabetes have 10
times the risk of heart attack as people without
diabetes.
Nathan acknowledged it's not easy to maintain
proper glucose levels. "It takes some work on the part of the
patient and the health-care team," he said. "For people with type 1,
they need to give themselves at least three injections of insulin a
day and check their blood sugars three to four times a day, and they
need to incorporate proper diet and exercise."
And what of
those patients who fail to take the recommended steps? "It's never
too late to start," advised Dr. Stuart Weiss, an assistant professor
of clinical medicine at New York University School of Medicine,
especially in light of the new findings.
"Even short periods
of tight control make for long-lasting reductions in complications,"
he said.
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