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Member Research and Reports

Member Research and Reports

Pittsburgh Epidemiologist Leads Report on Landmark Trial Showing Early Blood Glucose Control Extends Lifespan in Type 1 Diabetes

People with type one diabetes who intensively control their blood glucose soon after diagnosis are likely to live longer than those who do not, a recent report led by a University of Pittsburgh Graduate School of Public Health investigator revealed.

Orchard,Trevor
[Photo: Dr. Trevor Orchard]

Data from a long-running trial and follow-up observational study funded by the National Institutes of Health (NIH), with participants from 27 academic medical centers in the U.S. and Canada,showed a 33 percent reduction in deaths over the past several decades among participants who had early, good control of their blood glucose. The findings are detailed in the Journal of the American Medical Association (JAMA).

“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 Dr. Trevor Orchard, professor of epidemiology at Pitt Public Health. “These results also remove any lingering concern that intensive therapy may lead to increased mortality.”

The Diabetes Control and Complications Trial (DCCT) and the subsequent Epidemiology of Diabetes Control and Complications (EDIC) observational study have significantly changed treatment protocols for type 1 diabetes and improved the outlook for people with the condition over the past several decades, explained Dr. Griffin P. Rodgers, director of NIH’s National Institute of Diabetes and Digestive Kidney Diseases (NIDDK)

“Thanks to the findings over the years from the landmark DCCT/EDIC study, millions of people with diabetes may prevent or delay debilitating and often fatal complications from the disease,” said Dr. Rodgers. “NIH’s mission is to help improve lives through biomedical research. These kinds of results provide hard evidence that what we do helps people live longer, healthier lives.”

Beginning in 1983, the DCCT enrolled 1,441 volunteers between ages 13 and 39 with recent-onset type 1 diabetes. Half were randomly assigned to intensive efforts to keep blood glucose –also known as blood sugar – as close to normal levels as possible. The other half were assigned to the conventional treatment at the time, which simply sought to keep blood glucose levels from getting so high or low that patients would show symptoms, such as blurred vision or shortness of breath.

The trial ended in 1993 when the intensive group was found to have less eye, nerve and kidney disease. All participants were then taught the intensive blood glucose control techniques and early, good control of blood glucose was recommended for all people with type 1 diabetes. The EDIC study was then launched to continue tracking the health of all the participants.

Since 1983, 107 trial participants have died, with 64 in the group that originally received standard treatment, compared with 43 in the intensive treatment group.

The most common causes of death were cardiovascular disease at 22 percent, cancer at 20 percent and acute diabetes complications at 18 percent, all of which were more common in the group that originally received conventional treatment. Accidents or suicide were the fourth most common cause of death at 17 percent, with nominally more deaths in the people assigned to the early intensive treatment.