Type 1 diabetes can shave a decade off your life

People with type 1 diabetes lose more than a decade
of life to the chronic disease, despite improved
treatment of the illness and its complications – a new
Scottish study reports.
But, second study suggests that intensive blood sugar
management can make a difference.
Men with type 1 diabetes lose about 11 years of life
expectancy compared to men without the disease.
Impact on heart health
And, women with type 1 diabetes have their lives cut
short by about 13 years, according to a report
published in the Journal of the American Medical
Association .
The findings “provide a more up-to-date quantification
of how much type 1 diabetes cuts your life span now,
in our contemporary era,” said senior author Dr. Helen
Colhoun, a clinical professor in the diabetes
epidemiology unit of the University of Dundee School
of Medicine in Scotland.
Diabetes’ impact on heart health appeared to be the
largest single cause of lost years, according to the
study. But, the researchers also found that type 1
diabetics younger than 50 are dying in large numbers
from conditions caused by issues in management of
the disease – diabetic coma caused by critically low
blood sugar, and ketoacidosis caused by a lack of
insulin in the body.
“These conditions really reflect the day-to-day
challenge that people with type 1 diabetes continue to
face, how to get the right amount of insulin delivered
at the right time to deal with your blood sugar levels,”
Colhoun said.
Also Read: Technology lightens the burden of diabetes
A second study, also in JAMA , suggested that some of
these early deaths might be avoided with intensive
blood sugar management.
In that paper, researchers reduced patients’ overall risk
of premature death by about a third, compared with
diabetics receiving standard care, by conducting
multiple blood glucose tests throughout the day and
constantly adjusting insulin levels to hit very specific
blood sugar levels.
“Across the board, individuals who had better glucose
control due to intensive therapy had increased
survival,” said co-author Dr. Samuel Dagogo-Jack,
chief of the division of endocrinology, diabetes and
metabolism at the University of Tennessee Health
Science Centre in Memphis.
Strict control of blood sugar appears to be key.
Researchers observed a 44 percent reduction in overall
risk of death for every 10 percent reduction in a
patient’s haemoglobin A1c, a test used to determine a
person’s average blood sugar levels over the prior
three months, Dagogo-Jack said.
Damage to heart and blood vessels
The Scottish study looked at the life expectancy of
nearly 25,000 people with type 1 diabetes in Scotland
between 2008 and 2010. All were 20 or older. There
were just over 1,000 deaths in this group.
The researchers compared the people with type 1
diabetes to people without the chronic disease.
Researchers used a large national registry to find and
analyse these patients.
The investigators found that men with type 1 diabetes
had an average life expectancy of about 66 years,
compared with 77 years among men without it.
Women with type 1 diabetes had an average life
expectancy of about 68 years, compared with 81 years
for those without the disease, the study found.
Heart disease accounted for the most lost life
expectancy among type 1 diabetics, affecting 36
percent of men and 31 percent of women.
Diabetes damages the heart and blood vessels in
many ways, mainly by promoting high blood pressure
and hardening of the arteries, Colhoun said.
However, those younger than 50 appeared to die most
often from diabetes management complications.
In men, about 29 percent of life expectancy lost for
people under 50 was due to diabetes management-
related complications like diabetic coma or
ketoacidosis, a condition in which the body suffers
from high levels of poisonous acids called ketones.
These ketones are created when the body burns fat
for energy, because low insulin levels are preventing
the conversion of blood sugar into fuel. In women
under 50, that number was 22 percent, according to
the study.
Also Read: Better diet and exercise can prevent
diabetes in both sexes
Intensive treatment of their diabetes might have
extended these lives, Dagogo-Jack suggested.
In his study, more than 1,400 people with type 1
diabetes were randomly assigned to either receive
intensive management of their diabetes or normal
therapy.
People who got intensive therapy kept near-constant
tabs on their blood sugar levels, and made quick
adjustments to their insulin therapy to keep their blood
sugar as close to normal as safely possible, the study
reported.
The intensive therapy lasted an average of 6.5 years,
through the mid-1980s and 1990s. Afterward, patients
were taught how to conduct their own intensive
management and urged to continue using those
techniques. Doctors then tracked their health and
progress through the end of 2012.
After an average 27 years of follow-up, the researchers
found that the odds of dying were nearly one-third
lower for the intensive management group who kept
their blood sugar tightly controlled.
Diabetes management more achievable
Such intensive diabetes management is now more
achievable than it was back in the 1980s, when the
study began, said Dr. Ned Kennedy, chair of
endocrinology for the Cleveland Clinic.
“Time has moved on and technology has moved on
considerably,” Kennedy said. “Many patients now have
access to real-time multiple glucose measurements
during the day, either by doing finger stick
measurements or using continuous glucose
monitoring,” he explained.
“The real exciting developments are, we are getting to
the stage where we can marry up the information
from continuous glucose monitoring to the delivery of
insulin through insulin pumps,” Kennedy continued.
“This technology will make it easier for large numbers
of patients to reach the level of glucose control that
these patients achieved.”
As far as the ongoing loss of life expectancy to type 1
diabetes, both Colhoun and Dagogo-Jack said that the
Scottish findings can be looked at as positive.
People in the 1920s diagnosed with type 1 diabetes
had a life expectancy “on the order of months, clearly
less than one year,” Dagogo-Jack said.
On the right track
The discovery of insulin improved things somewhat,
but it wasn’t until the 1980s that medicine figured out
how to best use insulin to control blood sugar levels.
“It looks as though we are on the right track,” Colhoun
said. “Outcomes are improving, and I expect they will
continue to improve, but we are by no means there
yet.”
– Health24

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