Update in Endocrinology

Diabetes

Intensive Treatment of Type 1 Diabetes Had a Sustained Effect

In the Diabetes Control and Complications Trial (DCCT) (1), individuals with no clinically evident complications of type 1 diabetes or early microvascular complications were exposed to different levels of glycemic control for an average of 6.5 years. At the end of the trial, those in the intensive group were encouraged to continue tight control and those in the conventional group were encouraged to begin intensive therapy. After an additional 8 years, both groups had similar glycemic levels. This patient sample provides an opportunity to determine the effect of intensive therapy on the development and progression of diabetic nephropathy.

In the Epidemiology of Diabetes Interventions and Complications study, new cases of microalbuminuria developed in 6.8% of participants assigned to intensive therapy versus 15.8% of those in the conventional group. In addition, the intensive therapy group had fewer cases of hypertension (29.9% vs. 40.3%; P < 0.001), fewer instances of a serum creatinine level of 176.8 µmol/L or greater (≥2 mg/dL) (5 vs. 19 patients; P = 0.004), and fewer patients requiring dialysis or transplantation (4 vs. 7 patients; P > 0.2).

These observations suggest a carry-over or imprinting effect related to previous levels of glycemia. The mechanism for this apparent effect is unknown, but its existence emphasizes the importance of starting intensive therapy early in type 1 diabetes.

Optimizing Blood Glucose Control in Type 2 Diabetes

Riddle and colleagues' randomized, open-label, parallel 24-week multicenter trial compared the effectiveness of bedtime glargine or neutral protamine Hagedorn (NPH) insulin administered to 756 overweight male and female diabetic participants who were taking 1 or 2 oral agents. The insulin dose was titrated weekly (starting with 10 units) to a target fasting plasma glucose level of …