Intensive HbA1C control yields long-term benefits in type I diabetes mellitus

Insulin-syringesThough type I diabetes mellitus (T1DM) is not a public health problem in India, it is still a challenging disease for the physicians dealing with patients affected with it. Given the patient’s age of its onset, physicians and parents alike are deeply concerned about the long-term complications of the disease that the child might be exposed to in future. A new finding from the long-term follow-up study “Epidemiology of diabetes intervention and complications (EDIC)” gives some good news: intensive glycemic control in T1DM over a period reduces the risk of both long-term microvascular and macrovascular diabetic complications.

Key Point: There is emerging evidence that intensive lowering of blood glucose does not yield any cardiovascular benefits and in some patients even leads to adverse outcomes in patients with type II diabetes mellitus. But, in type I diabetes mellitus (T1DM), the results are contrary! This is yet another study in which HbA1C has been found to be a useful tool in long-term monitoring of glycemic control and risk stratification.

EDIC is an extended follow-up study of the landmark diabetes control and complications trial (DCCT). DCCT was an interventional study in which patients with T1DM were randomized into the intensive therapy (INT) group or the conventional (CON) therapy group. In the INT group, normal or near normal glucose and HbA1C were targeted with the use of at least three doses of daily insulin injections or the use of an insulin pump. In the CON group, one to two insulin injections per day were used with a daily urine or blood glucose test. Patients were followed up for 6.5 years. After the completion of the study, patients in the CON group were also advised to follow the same treatment strategy as the INT group.

alexander"This is an important study since the follow up period is long and the benefits of intensive glucose control on reduced complications is clear. The challenge, though, in this country is the cost and compliance in young patients taking insulin three times a day."
-Dr. Thomas Alexander, MD, DM, FACC, FICC, FCSI, Coimbatore, Tamilnadu, India. Dr. Alexander is an interventional cardiologist who is the Head of the Division of Cardiology at Kovai Medical Center and Hospital in Coimbatore, India and is a member of the mdCurrent-India Editorial Advisory Board.

Results of DCCT showed...

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