Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: MONDAY, June 14, 1993 TAG: 9306140580
SECTION: NATIONAL/INTERNATIONAL PAGE: A-1 EDITION: METRO
SOURCE: Newsday
DATELINE: LENGTH: Medium
Conventional treatment now calls for insulin-dependent diabetics to take a daily blood sugar test and one or two insulin shots a day.
"This is probably the most important study to come out in the diabetes arena in the last 25 years," said Kenneth Farber, executive director of the Juvenile Diabetes Foundation, based in New York. "Diabetics truly have a way now to do something about eye, kidney and nerve disease."
The study, presented Sunday at the annual meeting of the American Diabetes Association in Las Vegas, looked only at insulin-dependent, or Type I, diabetes, the rarer form affecting about 1.4 million Americans. But Farber and others believe it could ultimately apply to non-insulin-dependent, or Type II, diabetes, afflicting another 13 million.
"The standard of care should be to try to get the blood glucose level as close to normal as possible," said Dr. Xavier Pi-Sunyer, president of the American Diabetes Association.
In the study sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases, half of the patients were given the conventional treatment and put on a nutrition and exercise program.
The other half gave themselves blood tests four or more times a day by pricking their fingers. They then gave themselves three or four insulin injections or used a computer-operated insulin pump to automatically administer insulin into their abdomen, in order to keep their glucose levels as close to normal as possible.
The downside of the study, researchers said, was that those in the intensive therapy group suffered three times more often from hypoglycemia, or too-low blood sugar, and had a tendency to gain weight.
The increased risk of hypoglycemia, which can cause fainting, convulsions or coma, resulted from the difficulty of trying to mimic a normal body's insulin production. This is not a problem for most patients, who, when they get the symptoms - dizziness, sweatiness, jitters - can eat something to bring their blood sugar back up.
But in a minority of diabetics, the body doesn't signal the drop in blood sugar and the person can pass out, said Dr. Harry Shamoon of the Albert Einstein College of Medicine in the Bronx.
The benefits of intensive therapy "are fairly dramatic compared to the risks," said Dr. Robert Campbell of New York Hospital-Cornell Medical Center. \ INTENSIVE DIABETES CONTROL\ Approximate reductions in problems after switching from standard regimen for\ controlling blood sugar:\ \ 70 percent in progression of detectable diabetic retinopathy, an eye disease\ that can lead to blindness.
\ 50 percent in retinopathy becoming bad enough to be referred for treatment.
\ 50 percent in rates of treatment for sight-threatening retinopathy.
\ 50 percent in rates of significant kidney damage, called diabetic nephropathy.
\ 60 percent in rates of significant nerve damage called neuropathy.
by CNB