Managing Type 2 Diabetes - Managing Your Diabetes An Overview: Diabetes

Intensive treatment pays off

Just a few decades ago, experts weren't certain whether strictly controlling blood sugar levels offered people with diabetes long-term health benefits. Many health professionals didn't think fluctuations in blood sugar levels were detrimental and believed the enormous effort needed to maintain strict control of glucose wasn't worthwhile. By proving those theories wrong, the Diabetes Control and Complications Trial (DCCT) has had a profound impact on diabetes treatment.

In 1983, the DCCT Research Group, sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases, embarked on the largest, most comprehensive study of type 1 diabetes ever undertaken, enrolling 1,441 people at 29 medical centers in the United States and Canada. The 10-year DCCT revealed that keeping blood sugar levels as close to normal as possible significantly reduces the likelihood of complications such as eye, kidney, and nerve damage. Moreover, a follow-up investigation known as the Epidemiology of Diabetes Interventions and Complications (EDIC) study, which continues to follow DCCT participants, has so far shown that the health benefits of tight glucose control extend for the longer term — and may even get better with time.

How the study worked

To find out if strict control had any value, the DCCT compared the effects of then-current conventional diabetes treatment to more intensive therapy. Volunteers were divided into two groups. The control group was treated conventionally, receiving insulin once or twice a day and not aiming for any specific level of glucose control.

The intensive therapy group received at least three daily doses of insulin via injection or an insulin pump (see "Administering Insulin"), with the doses selected on the basis of glucose levels tested at least four times a day. Doses were adjusted to account for fluctuations caused by eating and exercising so as to maintain blood sugar levels at 70–120 mg/dL before meals and less than 180 mg/dL after meals. The overall goal was to lower the level of glycosylated hemoglobin, or HbA1c (see "Glycosylated hemoglobin test"), so it stayed within the normal range. Participants in this group also received extensive diabetes education.

Fewer long-term complications

The volunteers were followed, on average, for more than six years and watched for the onset or progression of eye, kidney, or nerve disease. Compared with the control group, the people receiving intensive therapy had average blood sugar levels that were 70–80 mg/dL lower and HbA1c readings that were 2% lower (7% vs. 9%).

Intensive therapy reduced the risk of developing diabetic retinopathy, a degenerative condition affecting the retinas of the eyes, by 76%. Tight control of blood sugar also lowered the risk for kidney disease (by 35%–56%) and nerve disease (by 60%). In addition, the progression of preexisting eye disease fell by 54%. And subsequent follow-up of the DCCT patients in the EDIC study suggests at least a 75% reduction in eye and kidney disease.

Although the overall youth of the participants (average age 27) precluded predictions about heart disease, the study did show that those undergoing intensive therapy had a 35% lower risk of developing high cholesterol, a major contributor to heart disease.

Although the DCCT demonstrated that tight glucose control has positive long-term effects, it also uncovered some disadvantages. Compared to conventional therapy, intensive treatment tripled the risk for hypoglycemia (low blood sugar). People who kept to the strict blood glucose regimen also gained some weight.

Benefits outweigh drawbacks

Still, the study's investigators concluded that for people with type 1 diabetes, the impressive long-term benefits outweighed the short-term drawbacks. Although the DCCT/EDIC studies didn't include people with type 2 diabetes, other studies have shown that tight blood glucose control minimizes their risk for complications as well. For example, the United Kingdom Prospective Diabetes Study followed more than 4,000 people newly diagnosed with type 2 diabetes who were placed on different treatment programs for more than a decade. Those who were treated intensively with insulin or oral hypoglycemic medications (sulfonylureas or metformin) had a lower incidence of major eye disease than those treated only with diet. This evidence suggests that intensive therapy is the optimal treatment goal for people with type 2 as well as type 1 diabetes.

Alternative treatments for diabetes

The immense growth in alternative therapies during the last 20 years has not bypassed diabetes treatment. Most people with diabetes who turn to alternative therapies do so to relieve the symptoms of complications, not to control their blood sugar levels.

For instance, acupuncture is sometimes used to control neuropathy, the painful nerve damage of diabetes. And biofeedback, which teaches people how to control some seemingly involuntary processes, is sometimes helpful for incontinence, one potential consequence of neuropathy.

While some mineral supplements have been studied to see if they can help people with diabetes control their blood sugar levels, so far not enough is known about such approaches to warrant recommending them. The most commonly studied supplements for managing diabetes are:

Chromium. Chromium is needed to make glucose tolerance factor, which aids the action of insulin. Several studies report that chromium supplementation may yield better diabetes control in people who are chromium-deficient. However, supplementation has shown no benefit for those who have adequate amounts of the mineral, and few people, including few people with diabetes, have a chromium deficiency.

Magnesium. Not having enough magnesium may increase insulin resistance. It may also impair secretion of insulin by the pancreas and contribute to certain complications of diabetes. But scientists still don't fully understand the relationship between magnesium and diabetes. As with chromium, the available evidence doesn't suggest that magnesium deficiency is a significant risk factor for diabetes, and the value of supplements remains speculative.

Vanadium. Some early studies of the compound vanadium found that it normalized blood sugar levels in rats with type 1 or type 2 diabetes. A more recent study found that when people with type 2 diabetes were given vanadium, they became slightly more sensitive to insulin and were able to lower their insulin doses. However, this effect did not extend to people with type 1 diabetes. And research on vanadium is limited. Researchers still don't understand exactly how it works or whether it has any side effects.

A final word of warning: "Natural" and "alternative" are not synonymous with safe or effective. If you want to try an alternative therapy, talk to your doctor first. Certain supplements, for instance, may be especially dangerous for someone with kidney disease.