Intensive Diabetes Management and Diabetes Complications

Following the awarding of the Nobel Prize in medicine (1923) for the discoverers of insulin, Dr, Elliott Joslin predicted that the era of the coma as the central problem of diabetes would give way to the era of diabetes complications. No longer are patients with diabetes dying of diabetic ketoacidosis, insulin has allowed people with diabetes to live longer. Many of this individuals who are not aggressively managed, especially from the onset of diabetes, will develop diabetes complications that are costly to themselves as well as to society. The era of death from diabetic coma was transformed into an era of death from diabetes complications by the discovery of insulin.

The pathologic triggers for diabetes complications are prolonged hyperglycemia with A1C levels greater than 7 percent, wild blood glucose swings, and the production of reactive oxygen species within complication-prone cells. Majority of diabetes complications can be divided into two categories: microvascular diabetes complications and macrovascular diabetes complications. Microvascular diabetes complications include retinopathy, neuropathy, and nephropathy. Macrovascular diabetes complications include coronary heart disease, stroke, myocardial infraction, and peripheral vascular disease. Diabetes complications rates can be significantly delayed or reduced by implementing intensive diabetes management to patients immediately following initial diabetes diagnosis.

Intensive diabetes management can greatly reduce microvascular complication risk. By only improving A1C levels by 2 percent person with diabetes can reduce risk of neuropathy complication of diabetes by 60 percent, nephropathy by 54 percent, and retinopathy by 63 percent. It doesn’t say much in simple words. How about this: individuals with sugar diabetes could gain 15 years of diabetes complication-free life and live 5 years longer if they were to adhere to intensive diabetes management while striving to achieve an A1C level lower than 7 percent.

Little doubt exist today regarding the benefits of intensive management of all forms of diabetes with the intent of delaying or preventing long-term and short-term diabetes complications. Before the results of the Diabetes Control and Complication Trial were published in 1993, the most popular treatment for Type 1 diabetes was twice daily NPH-insulin injection using two thirds of the total insulin dose before breakfast and one third before dinner. Outcomes of this treatment protocol were predictably poor.

The United Kingdom Prospective Diabetes Study determined that patients with Type 2 sugar diabetes can also benefit from intensive diabetes management. Each 1 percent reduction in A1C is accompanied by a 35 percent decrease in the risk of microvascular (neuropathy, retinopathy, and nephropathy) complications. This study confirmed that hyperglycemia as a toxic metabolic state regardless of the etiology of diabetes or the age at which the patients is affected. Both studies illustrate the importance to treat patients to target A1C lower than 7 percent with intensive diabetes management attempting in the same time to achieve as close to a normal metabolic state as is safely possible.

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