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Early Intensive Glucose Control Cut Neuropathy Risk in Type 1 Diabetes


 

ORLANDO, FLA.–Early implementation of intensive blood glucose control reduces the risk for neuropathy in patients with type 1 diabetes, even if their control worsens down the line, Catherine L. Martin reported at the annual scientific sessions of the American Diabetes Association.

“Intensive therapy should be implemented as early as possible so as to obtain maximal long-term benefit,” said Ms. Martin of the University of Michigan, Ann Arbor.

The finding is the latest to come from the Epidemiology of Diabetes Interventions and Complications (EDIC) study, a long-term follow-up of 96% of the original 1,441 participants in the landmark Diabetes Control and Complications Trial (DCCT), which confirmed the link between intensive glucose control and a reduced risk of microvascular complications in patients with type 1 diabetes (N. Engl. J. Med. 1993;329:977–86).

In the DCCT, patients who practiced intensive blood glucose control and achieved an average hemoglobin A1C level of 7.2% had a 64% lower risk for developing clinical neuropathy at an average follow-up of 5 years, compared with the conventionally treated group whose HbA1C levels averaged 9%.

After the trial ended in 1993, the subjects in the conventionally treated group were instructed in intensive glucose management techniques, and all subjects were referred back to their personal physicians while continuing to be monitored annually in EDIC from 1994 onward, said Ms. Martin, the study coordinator for DCCT/EDIC at the University of Michigan.

By year 8 of EDIC, glucose control had improved in the DCCT conventionally treated patients to a mean HbA1C level of 8.2%, while at the same time it had worsened in the former intensive treatment group to a mean of 8%.

But despite the convergence, 9.4% of the DCCT conventional group scored 7 or greater on the 15-item Michigan Neuropathy Screening Instrument (MNSI) symptom questionnaire at year 8, compared with 5% of the DCCT intensive group. On the five-component MNSI foot exam (appearance, ulceration, vibration, ankle reflex, and response to the 10-g monofilament), 33% of the DCCT conventional group scored 2.5 or greater vs. 23% of the intensive group.

Differences between the two groups on both neuropathy measures had reached significance by year 1 and remained so for each of the 8 years. Overall, the relative risk for neuropathy in the DCCT intensive group was reduced by 36% for the MNSI exam and by 50% for the MNSI questionnaire.

Similar findings of a persistent, beneficial effect of a prior period of glycemic control on the subsequent development of retinopathy and nephropathy at 8 years were reported at last year's ADA meeting by another EDIC investigator.

And in a published report, the progression of intima-media thickness, a measure of atherosclerosis, was also significantly lower 6 years later in the DCCT intensive group (N. Engl. J. Med. 2003;348:2294–303).

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