How Diabetes Treatment Got More Intense in 1993

03/31/07 Type II Diabetes, Type I Diabetes or Juvenile Diabetes, Treatment Options, Disease Basics, General

• Three or more insulin injections each day
• Consistent and frequent blood glucose checks (more than the two to four per day that has been a standard)
• Flexible dosing of insulin to account for changes in meals and activities
• Exercise, nutrition and weight loss therapy
• Anti-diabetes medication, where appropriate
• Aspirin therapy
• Monitoring blood pressure
• Keeping records of blood glucose and blood pressure readings to guide decisions with health care providers
• Using an insulin pump and/or blood glucose sensing system

By contrast, "standard" diabetes treatment usually centers on one or two insulin injections each day, some diet modification and medication, and two to four blood sugar checks. Comparatively, intensive diabetes care is demanding and regimented. It becomes your life, so it may not be for everyone. (See Diabetes Burnout article below.)

Certainly this is a generic description of intensive diabetes therapy. If you choose to adopt it, your plan will vary according to type 1 versus type 2, age, body mass index, the duration of your diabetes, and many other factors. Your doctor will help you fine-tune a plan that works well for your situation.

When Did Intensive Diabetes Therapy Catch On?
In 1993, John M. Lachin, a medical statistician, and a team of of researchers published the results from a multiyear diabetes study. The Diabetes Control and Complications Trial (DCCT) concluded that type 1 patients who maintained blood glucose levels close to normal readings experienced:

• 50 percent less risk of kidney damage.
• 76 percent less risk of eye damage.
• 60 percent less risk of nerve disease.

However, the researchers also pointed out that the intensive diabetes therapy patients also experienced three times more hypoglycemia.

Keep in mind that the study only enrolled patients living with type 1 diabetes, so they were insulin dependent. However, medical scientists later verified that the DCCT conclusions also helped type 2 diabetics. Doctors certainly wanted to know if such tight blood sugar control would also benefit people with some remaining pancreas and insulin function.

In 1998, a British team published its major findings from a study that focused on intensive diabetes therapy in type 2 diabetics. The United Kingdom Prospective Diabetes Study (UKPDS) enrolled more than 5,000 patients and published its results in the journals Lancet and the British Medical Journal. The researchers determined that patients who participated in intensive diabetes therapy and successfully lowered their A1C scores by 1 percent:

• Lessened their chances of micro vascular problems by 35 percent.
• Experienced a 16 percent reduction of heart attack risk.
• Experienced 25 percent reduction of diabetes-related retina damage.

One group of patients within the study also focused on strictly managing blood pressure with medication. Those who successfully reduced their blood pressure:

• Reduced their micro vascular complications by 37 percent.
• Experienced 44 percent fewer strokes
• Experienced 47 percent less incidence of retinal disease.

Is Intensive Diabetes Therapy For Everyone?
The rigors of intensive diabetes treatment are not for everyone. If an individual is unable to keep up with it, or the worry will outweigh the potential benefits (Isn't reducing stress a key to fighting diabetes?), it could end up causing more problems. The most significant danger that comes from intensive diabetes therapy is hypoglycemia. Depending on how your body reacts, you could find that you drive your blood sugar levels too low from time to time. Type 1 diabetics have a heightened risk of hypoglycemia. Intensive diabetes therapy is more expensive, over the short run, than traditional care. It is easy to see that avoiding eye surgery, heart procedures, kidney dialysis, and other expensive procedures would tend to save more money after years of living with diabetes. Still, if a person is in a financial pinch, they feel every cent. The additional test strips, insulin, syringes, and medications could double or triple the monthly expense of living with diabetes. If a person lacks insurance coverage, or has high deductibles, they may struggle to cover this additional expense. What Next?
My Diabetes Information exists to educate you about living with diabetes so you can thrive as much as possible. We give you information that teaches you the language of diabetes and the treatment possibilities. It is your job to take your new knowledge to your doctors and diabetes educators, and ask them questions. If the ideas in this story are new to you, we suggest making an appointment with your doctor. Your physician may not have introduced you to intensive diabetes therapy for a number of reasons. Your doctor will use your questions, history, and unique qualities to refine your diabetes strategy. You may be ready for it now. Some of the key questions you may consider asking include:

• What is the next step I need to take to improve my blood glucose control?
• Would it help me to customize my insulin injections according to my exercise and eating habits?
• How often should I check my blood sugar?
• Would some of the new diabetes-related medications benefit me? (Remember, they are expensive.)
• Could aspirin therapy help me?
• What types of blood sugar and blood pressure records should I share with you?
• Am I a good candidate for an insulin pump or blood glucose sensing system?