Glucose control spares arteries in diabetes

Physicians implore diabetes patients to monitor their blood concentrations of glucose and keep them in check. A new study suggests that exceptionally strict glucose control can have long-term benefits by helping patients avoid heart disease, the leading complication of diabetes.

Between 1983 and 1993, researchers tracked 1,441 people with type I, or juvenile-onset, diabetes. The team had assigned half the participants to receive insulin and standard counseling for their disease. The others had followed a program of checking blood glucose more frequently and taking extra insulin injections as needed.

The researchers then placed all study participants on the strict glucose program. After 6 more years, the researchers used ultrasound to measure the thickness of each patient’s carotid arteries, which supply the brain with blood. Vessel-wall thickness is a reliable indicator of nascent atherosclerosis.

“Carotid thickening has been associated with adverse [cardiovascular] events later on,” says David M. Nathan of Harvard Medical School in Boston.

In the study, the people who had been intensively monitored and treated for 10 years had only 76 percent as much artery thickening as did those originally on standard treatment. Nathan reported the finding this week in Philadelphia at the annual scientific sessions of the American Diabetes Association (ADA).

The results bolster previous studies showing that strict glucose control reduces eye, nerve, and kidney complications stemming from type I diabetes, Nathan says. He predicts that strict glucose control will also benefit people with type II, or adult-onset, diabetes.

Christopher D. Saudek of Johns Hopkins University Medical Institutions in Baltimore and ADA’s president says that the work posts a warning for physicians and patients: Poor control of glucose concentrations can have long-term consequences.