Featured Research

from universities, journals, and other organizations

Improved blood glucose control slows progression to end-stage renal disease in type 1 diabetes

Date:
June 5, 2014
Source:
Joslin Diabetes Center
Summary:
People with Type 1 diabetes who have developed kidney complications can slow the progress of their complications by improving control of their blood glucose over the long term, the results of a 20-year study confirm. This finding may lead to changes in clinical practice for this population.

People with type 1 diabetes who have developed kidney complications can slow the progression of their complications by improving control of their glycemic (blood glucose) levels over the long term.

Related Articles


This finding, which may change clinical practice at many institutions for this population, was drawn from a long-term observational study led by Andrzej Krolewski, M.D., Ph.D., head of Joslin Diabetes Center's Section on Genetics and Epidemiology.

Running for almost 20 years, the study showed that "you have to improve glycemic control for a long period of time to see this effect among these patients," emphasized Krolewski, who is also a professor of medicine at Harvard Medical School.

Published in the Journal of the American Society of Nephrology, the study followed a cohort of type 1 diabetes patients in the Joslin Clinic who had developed proteinuria. (Proteinuria is a potential kidney complication in which urine contains elevated amounts of protein; albumin is typically the most common protein found). The condition frequently leads to end-stage renal disease (ESRD), a life-threatening ailment that can only be treated with kidney dialysis or transplant.

The Joslin study began tracking kidney impairment among the patients in 1991 and followed them until 2011. As part of the study, researchers collected measurements of glycolated hemoglobin (HbA1c), which provides an indication of average blood glucose levels, for 279 patients.

All patients with type 1 diabetes produce little or none of the hormone insulin, and depend on insulin injections to stay alive. To maintain their health and minimize kidney problems and other complications, they must actively control their glycemic levels by paying attention around the clock to their blood glucose levels, diet and exercise. Endocrinologists generally recommend an HbA1c goal of 7.0% or below, but achieving that level of control is difficult. The patients with proteinuria in the study were generally poorly controlled, with an average HbA1C of 9.3% before the study began.

Earlier investigations had suggested that achieving better glycemic control did not slow kidney complications for such patients. However, those studies were small and only extended for several years. In contrast, the Joslin research showed that those who lowered their HbA1C levels demonstrated a significantly lower risk of ESRD after a lag period of about five years. After 15 years, those with improved glycemic control had a cumulative risk of ESRD of 29% while those whose HbA1c increased or remained poor had a risk of 42%. There were no detectable differences between these two groups at the start of the study.

"The number of patients with diabetic kidney disease continues to grow at an epidemic rate throughout the rest of the world," said Robert Stanton, M.D., chief of the Kidney and Hypertension Section at Joslin and coauthor on the paper. "There is a great need to find new approaches and new treatments to both prevent development of diabetic kidney disease and to slow progression. This long-term study provides an important rationale to both patients and doctors to improve glycemic management in people with type 1 diabetes and kidney disease and to work very hard to maintain the glycemic control over many years."

Importantly, patients with proteinuria could substantially postpone severe outcomes from the disease without maintaining optimal HbA1c levels, Krolewski said. "We are talking about improving HbA1c from 11% to 9%, or 10% to 8%," he said, adding that earlier work by his lab indicated that levels of HbA1c below 8-9% may be sufficient to avoid kidney damage.

Down the road, Krolewski has high hopes for the emergence of "smart insulins," which have been modified to automatically release the hormone once blood glucose levels rise above certain levels. When and if these drugs become available, he speculated, they might prove highly effective for slowing down progression to ESRD among this group of patients even if the drugs maintain higher than ideal glycemic levels.

Most people with type 1 diabetes will never proceed to ESRD, even if their glycemic control is far from perfect. Among the estimated 80,000 in the United States who have developed proteinuria, Krolewski said, about 10% are "rapid progressors" whose kidney function deteriorates completely within a few years.

Examining risk factors in developing kidney disease, researchers in his lab found in 2012 that high concentrations of the proteins TNFR1 and TNFR2 in blood accurately predict the risk of kidney function loss in both type 1 and type 2 diabetes 10 years in advance. This work has been licensed to EKF Diagnostics, a European firm now developing a commercial diagnostic test. Eventually, Joslin scientists hope, tests will identify diabetes patients at risk of impaired kidney function. Those patients then can be given special efforts to improve their glycemic control, and perhaps eventually also receive new combinations of drugs tailored to their condition.

Changes in clinical practice are usually driven by clinical trials, which compare results for multiple groups of patients who receive different treatments, rather than by observational investigations such as the Joslin proteinuria study. Krolewski noted, however, that a prospective clinical trial cannot be designed to address questions about effects of improved long-term glycemic control on progression to ESRD since it would not be ethically appropriate to purposely maintain a control group of patients with very high levels of blood glucose.


Story Source:

The above story is based on materials provided by Joslin Diabetes Center. Note: Materials may be edited for content and length.


Journal Reference:

  1. J. Skupien, J. H. Warram, A. Smiles, A. Galecki, R. C. Stanton, A. S. Krolewski. Improved Glycemic Control and Risk of ESRD in Patients with Type 1 Diabetes and Proteinuria. Journal of the American Society of Nephrology, 2014; DOI: 10.1681/ASN.2013091002

Cite This Page:

Joslin Diabetes Center. "Improved blood glucose control slows progression to end-stage renal disease in type 1 diabetes." ScienceDaily. ScienceDaily, 5 June 2014. <www.sciencedaily.com/releases/2014/06/140605190702.htm>.
Joslin Diabetes Center. (2014, June 5). Improved blood glucose control slows progression to end-stage renal disease in type 1 diabetes. ScienceDaily. Retrieved October 30, 2014 from www.sciencedaily.com/releases/2014/06/140605190702.htm
Joslin Diabetes Center. "Improved blood glucose control slows progression to end-stage renal disease in type 1 diabetes." ScienceDaily. www.sciencedaily.com/releases/2014/06/140605190702.htm (accessed October 30, 2014).

Share This



More Health & Medicine News

Thursday, October 30, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Fauci Says Ebola Risk in US "essentially Zero"

Fauci Says Ebola Risk in US "essentially Zero"

AP (Oct. 30, 2014) NIAID Director Anthony Fauci said the risk of Ebola becoming an epidemic in the U.S. is essentially zero Thursday at the Washington Ideas Forum. He also said an Ebola vaccine will be tested in West Africa in the next few months. (Oct. 30) Video provided by AP
Powered by NewsLook.com
Nurse Defies Ebola Quarantine With Bike Ride

Nurse Defies Ebola Quarantine With Bike Ride

AP (Oct. 30, 2014) A nurse who vowed to defy Maine's voluntary quarantine for health care workers who treated Ebola patients followed through on her promise Thursday, leaving her home for an hour-long bike ride. (Oct. 30) Video provided by AP
Powered by NewsLook.com
Pot-Infused Edibles Raise Concerns in Colorado

Pot-Infused Edibles Raise Concerns in Colorado

AFP (Oct. 30, 2014) Colorado may have legalized marijuana for recreational use, but the debate around the decision still continues, with a recent - failed - attempt to ban cannabis-infused edibles. Duration: 01:53 Video provided by AFP
Powered by NewsLook.com
British Navy Ship Arrives in Sierra Leone With Ebola Aid

British Navy Ship Arrives in Sierra Leone With Ebola Aid

AFP (Oct. 30, 2014) The British ship RFA ARGUS arrived in Sierra Leone to deliver supplies and equipment to help the fight against Ebola. Duration: 00:42 Video provided by AFP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins