Diabetes Forecast

Benefits of Tight Control

By Tracey Neithercott ,

Need another reason to lower your A1C? A study published today in the Archives of Internal Medicine confirms that tight control of blood glucose levels pays when it comes to preventing diabetes-related complications.

To be more specific: After 30 years with type 1 diabetes, participants who practiced tight control for 6 1/2 years after diagnosis lowered their rate of retinopathy by more than half, kidney disease by almost two-thirds, and cardiovascular disease by nearly half, compared with those on a more lenient treatment plan. The intensive therapy group used multiple daily insulin injections or an insulin pump, plus at least four blood glucose checks per day, to maintain an A1C of around 7 percent during that period.

After the 6 1/2-year trial, both groups returned to their primary care physicians with instructions to follow intensive therapy. Even though the two groups had little difference in A1C years later, the findings suggest that tight control early on can reduce complications dramatically. The American Diabetes Association recommends keeping an A1C of at or under 7 percent for good glucose control.

"It really just reinforces that even though we know it's really hard work, there are benefits to getting as close to 7 as you can, even early on," says Richard Bergenstal, MD, ADA's president-elect of medicine and science and a principal investigator for the study.

Although the study was conducted in people with type 1 diabetes, its message can be applied to people with type 2, says Bergenstal. In fact, the largest study in people with type 2 diabetes recently found that, 20 years after being diagnosed, those whose A1C hovered around 7 percent were less likely to have complications.

According to the study's authors, intensive treatment started as soon as diabetes is diagnosed—which was not standard practice when the study started in 1983—should lead to a 50 percent reduction in rates of complications in the future.



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