Keeping Blood Glucose on Track

Over the past several years, we have gained a much better grasp of the relationship between blood sugar and diabetic complications. Two research trials in the 1990’s though showed that blood sugar control can prevent diabetes-related health issues such as eye disease, kidney problems, nerve damage and heart disease. This research has helped health care providers to set healthy ranges of blood sugar levels for diabetics to use as targets to avoid complications.

Type 1 Diabetes

The first trial, The Diabetes Control and Complications Trial (DCCT), lasted almost ten years and enrolled people with Type 1 Diabetes to receive either standard therapy or intense therapy. Intense therapy was given with the hope of keeping blood sugar levels as close to normal as possible by giving three to four doses of insulin daily. The intense therapy group had an average A1C of 7.2% compared to the 9% A1C of those in the standard therapy group.

On average, the blood sugar in the intense therapy group was 150 mg/dL (milligram per deciliter) compared to 230 mg/dl for the standard group. For those patients that had near normal blood sugars in the intense therapy group, their risk of onset of diabetic complications was reduced by 34 to 76 percent.

The result of the DCCT study was that for patients with Type 1 Diabetes, blood sugars that are as close to normal as possible (average HbA1c of 7.2%, average blood sugar value of 150 mg/dl) would help to reduce the chances of onset of diabetic complications.

Type 2 Diabetes

After the DCCT, the question still remained, “Did tight blood sugar control prevent complications with patients with type 2 diabetes?” A large trial in England, called the United Kingdom Prospective Diabetes Study (UKPDS) was performed to answer this question. The study followed more than 5,200 people with newly-onset type 2 diabetes for about ten years.

There was an intense therapy group and a standard therapy group, with patients in the intense therapy group having an A1c of 7.0% and patients in the standard therapy group having an A1c of 8.0%. Patients in the intense therapy group showed slower onset of diabetic eye disease and diabetic kidney disease, and lowered their risk of having a heart attack. This study showed that near normal blood sugar levels reduced the chance of small and large vessel disease in patients with type 2 diabetes.

What should be taken from the two trials?

As a result of these two landmark trials, the American Diabetes Association (ADA) has emphasized that the targets for HbA1c and blood sugars should be as close to normal as possible.

Is your blood sugar tightly controlled?

Treatment for patients with type 1 and 2 diabetes needs to focus on meal planning, staying active, and using diabetes medication or insulin to reach your target blood sugar goal. Your health care team will prescribe the right diabetic medication or insulin for you.

In checking your blood sugars, if you note a pattern of blood sugars greater than 120 mg/dl in the morning or at bedtime, you should contact your health care provider to talk about what you could do to lower your blood sugar levels. Changing your medicine dosage, changing your lifestyle or increasing insulin may be needed to reach your blood sugar goals.  Your blood sugar goals should be set by your healthcare team since very tightly controlled blood sugar may not be right for those with a grave illness. Be sure to check your glucose level and visit your doctor often to ensure that you are on target with your diabetes health goals.

Questions for your doctor

When you visit your doctor, you may want to ask:

• Am I a candidate for intense therapy?

• What should my blood glucose levels be to stay healthy?

• Can I be referred to a diabetes educator to teach me how to monitor my blood sugars?

• How should I eat?

• How often should I stay active to control my blood sugars?

• Do changes in my medications need to be made to better control my blood sugars?

Conclusion

Blood glucose control has become a fine art with new medications and forms of insulin now able to make it easy for diabetics to achieve near normal blood sugars. New research confirmed that blood sugar control will reduce the risk of onset of diabetes complications such as heart, kidney, and eye disease. Therefore, if you know your goals and know your numbers, you can work with your health care provider to make your diabetes health goals come true.