Good diabetes control halves kidney disease risk

 Intensive control of type 1 diabetes to maintain near-normal blood glucose levels halves the long-term risk of kidney disease, according to a US trial funded by the National Institutes of Health (NIH).

The landmark Diabetes Control and Complications Trial (DCCT) followed patients for more than 20 years following a 10-year trial period.

The results provide definitive evidence of the long-term benefits of careful medication adjustment soon after diagnosis to optimise the value of insulin and other diabetes-controlling drugs.

This finding adds significantly to the body of evidence supporting an intensive control strategy, despite the financial and logistical challenges it presents, and endorsing the use of new types of insulin and drug delivery strategies that help to address those challenges.

The DCCT was conducted from 1983 to 1993 in 1,441 people with type 1 diabetes, an average of six years after diagnosis. Half of them used conventional blood glucose control (based on daily testing) in the trial and half used a more intensive approach.

After an average of 22 years follow-up, 24 in the intensive group developed significantly reduced kidney function compared to 46 in the conventional group. Intensive control also reduced eye and nerve damage.

Griffin P. Rodgers, Director of the NIH’s National Institute of Diabetes and Digestive and Kidney Diseases, which oversaw the DCCT, commented that it showed “the value of long-term studies”.

“The full benefit of treatment may not be seen for decades, especially for complications of diabetes, such as kidney disease, which can progress slowly but have devastating consequences,” he said.

Diabetes is a leading cause of kidney failure – in the US, it accounts for 38% of patients on dialysis or living with a kidney transplant.