TUESDAY, March 29 (HealthDay News) -- While complications from
type 1 diabetes are common, they aren't inevitable. New research
suggests that some people with the disease apparently have an
inherent protection against serious complications, such as eye,
kidney and heart disease.
In a group of people who'd had type 1 diabetes for more than 50
years, nearly 43 percent remained free of serious eye disease,
while about 87 percent never developed kidney disease, nearly 40
percent were free of nerve damage and more than 50 percent were
free of cardiovascular disease, according to the study.
"We have identified a group of people who can clearly live well with diabetes for a long time," said the study's senior author, Dr. George King, chief scientific officer at the Joslin Diabetes Center in Boston. "Now, we're in the process of finding out why. In the meantime, if you have type 1 diabetes, try to control your disease. The reason that most of them eluded the problem of complications is that they manage their disease pretty well," said King.
But, this study found that even in this group of people who --
on average -- maintained good blood sugar control, some developed
complications, while others appeared to have some sort of
protection against them.
Results of the study are published in the April issue of
Almost 26 million Americans have diabetes, according to the U.S.
Centers for Disease Control and Prevention (CDC). About 5 percent
of those have type 1 diabetes, the CDC estimates. Type 1 diabetes
is an autoimmune disease in which the body's immune system
mistakenly attacks the insulin-producing cells in the pancreas.
Insulin is a hormone that's necessary for the body and brain to be
able to use the sugars found in carbohydrates as fuel. People with
type 1 diabetes must take replacement insulin, through injections
or an insulin pump, all of their lives.
Without insulin, or without enough insulin, the body can't use
blood sugar for fuel, and the sugar builds up in the bloodstream.
Long-term high blood sugar levels can cause a number of serious
problems, including diabetic retinopathy in the eyes, kidney damage
and possibly failure, nerve problems and heart disease.
Previous research has shown that good control of blood sugar
levels can help prevent these complications. But, it's difficult to
keep blood sugar levels low without going too low (hypoglycemia), a
potentially dangerous condition itself.
For the current study, the researchers assessed complications in
a group of 351 people with long-standing type 1 diabetes. These
people were part of a group known as the diabetes "medalists."
They've lived for more than 50 years with type 1 diabetes, and were
initially diagnosed at a time when good blood sugar control wasn't
really possible because blood glucose meters and other technologies
that help people live with diabetes today just weren't available
The average A1C level in this group was 7.7 percent. A1C is a
measure of blood sugar control over several months. People without
diabetes have levels under 6 percent.
Overall, King said, about 35 percent of the medalists didn't
develop any serious problems related to their diabetes. "There's
something in those 35 percent that protects them from diabetic eye,
kidney, nerve and heart disease," said King.
And exactly what that protective mechanism might be isn't yet
known. It's hard to create a control group for comparison to the
unusual group of diabetes survivors, the study noted. In addition,
the protective mechanism may be different for microvascular
complications (such as kidney and eye disease) and macrovascular
complications (such as heart disease), according to background
material accompanying the study.
One potential reason is suggested by a certain combination of
substances called advanced glycation end products (AGEs), which the
study found were 7.2 times more common in people with
complications. AGEs develop in the body after long-term exposure to
high blood sugar levels.
This particular combination of AGEs (high plasma
carboxyethyl-lysine and pentosidine) was linked to complications,
but other AGE molecules appeared to have a protective effect -- an
exciting finding the researchers said may lead to new biomarkers
for protection against complications.
And there may be other ways to keep the problematic AGEs under
The author of an accompanying editorial, Dr. Aaron Vinik, noted
that a receptor for AGE called sRAGE is lacking in people with
complications. "When you have diabetes early on, you have about a
50 percent reduction in sRAGE. People who develop serious
complications have an 85 percent reduction in sRAGE. So, the best
predictor of longevity and freedom from complications may be a good
sRAGE mechanism," explained Vinik, who is the director of the
Eastern Virginia Medical School Strelitz Diabetes Center in
Vinick also pointed out that many of the drugs that are commonly
prescribed today to help people with diabetes live longer and
better lives -- such as ACE inhibitors to control their blood
pressure and statins to control their cholesterol levels -- raise
Both King and Vinik said that once researchers figure out
exactly which substances are at play in those who are protected
from diabetes complications, the findings could lead to ways to
screen for those most at risk of complications, and potentially to
a treatment that could help prevent complications.
King said that while the researchers figure out how to better
protect people with diabetes from complications, good blood sugar
control remains the cornerstone of diabetes management. He added
that the medalists as a group tended to be very proactive and
involved in their diabetes care.
"In general, the medalists control their disease rather than letting the disease affect their life patterns. This is a group of patients that manages things rather than let things manage them," said King.
Learn more about type 1 diabetes and how to manage it from the
U.S. National Library of Medicine.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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