PITTSBURGH - People with type 1 diabetes who intensively control their blood glucose soon after diagnosis are likely to live longer than those who do not, according to a study published online Tuesday in the Journal of the American Medical Association.
Over about three decades, the group whose diabetes was tightly controlled for the first seven years after diagnosis had a 33 percent reduction in deaths, as compared with those whose diabetes was not as well-controlled.
The study initially involved 1,441 people.
"We can now confidently tell doctors and patients that good, early control of blood glucose greatly reduces any risk for early mortality in people with type 1 diabetes, usually diagnosed in children and young adults," said lead author Trevor Orchard, professor of epidemiology at the University of Pittsburgh Graduate School of Public Health.
The delicate balancing act for those with type 1 diabetes requires blood-glucose levels close to normal without going over the cliff of low blood sugar, which can lead to unconsciousness, coma, and even death without emergency doses of carbohydrates or sugar.
So the long-standing debate in diabetes care is how close should one get to the normal range with the daily risk of going over the cliff. Conventional strategy has favored elevated blood-sugar levels to avoid the more immediate emergencies of low blood sugar. But that strategy also increases the risk of long-term diabetes complications including heart disease, stroke, cancer, nerve damage, kidney disease and blindness, among others.
In the study, 43 deaths occurred among the group that followed the intensive-control strategy, as compared with 64 deaths in the conventional group. While the statistical significance reflected only a modest benefit for the intensive-control group, given the small numbers involved, Orchard said the 19 fewer deaths in the intensively controlled group were notable, especially given the fact that few deaths occurred from low blood sugar, known as hypoglycemia.
"There was concern that increased control might incur an increased risk of death," Orchard said. "Now we are saying the risk is not being realized and intensive therapy overall leads to a reduction in mortality."