A new study has found that long-term risk of an impaired glomerular filtration rate (GFR), which leads to end-stage renal disease and increases the risks of cardiovascular disease and death, was significantly lower among persons treated early in the course of type 1 diabetes with intensive diabetes therapy than among those treated with conventional diabetes therapy.
An impaired GFR is the final common pathway of diabetic kidney disease. Once the GFR is impaired, cardiovascular disease events and progression to end-stage renal disease occur at unacceptably high rates, even with proven medical management. The researchers reviewed data from the Diabetes Control and Complications Trial (DCCT) and the observational study that followed it, the Epidemiology of Diabetes Interventions and Complications (EDIC) study. The DCCT included more than 1,400 people with type 1 diabetes who were randomly assigned to receive either intensive diabetes management or conventional diabetes therapy at the time (1980s).
Intensive management was aimed at lowering hemoglobin A1c levels (HbA1c) to less than 6.05 percent. HbA1c is a long-term (about two to three months) measurement of blood sugar levels, and levels below 6.05 percent are similar to levels for people who don’t have diabetes. Lower numbers generally translate into a lower risk of serious complications. The DCCT lasted for 6.5 years, and the EDIC trial currently has 16 years of follow-up data.
During the DCCT, people in the intensive management group averaged an HbA1c of 7.3, while the conventional group had an HbA1C average of 9.1 percent. During EDIC, both groups had HbA1Cs around 8 percent.