Long-Term Blood Sugar Control Delayed Kidney Problems

Blood sugar control for 10 years or more slowed development of kidney failure in type 1 diabetes patients

(RxWiki News) Managing blood sugar levels is a central part of treating diabetes and preventing complications related to diabetes. And now, new research has reinforced that important fact.

Keeping blood sugar at a healthy level for a decade or more may slow the onset of kidney problems associated with type 1 diabetes, according to a long-term clinical study.

Previous research, covering a shorter time frame, failed to find this link between blood sugar control and the delay of kidney problems.

"Control blood sugar levels to fend off diabetes-related complications."

Andrzej Krolewski, MD, PhD, head of the Joslin Diabetes Center's Section on Genetics and Epidemiology in Boston, MA, led this research.

The 20-year study examined how long-term control of blood sugar levels in patients with type 1 diabetes influenced kidney health.

Type 1 diabetes occurs when the pancreas stops producing enough of the hormone insulin, which moves sugar from the blood into cells, which use the sugar for energy. The condition usually develops earlier in life.

Symptoms of type 1 diabetes include fatigue, nausea and numbness in the extremities. The main treatments include insulin injections and changes to diet and exercise.

If blood sugar levels remain too high, over time it can affect the kidneys, the body’s blood filtering organs. This effect can ultimately lead to kidney failure. After kidney failure, patients need either dialysis (a procedure in which a machine filters blood in place of the kidneys) or a kidney transplant.

Dr. Krolewski, also a professor at Harvard Medical School, and team followed 349 type 1 diabetes patients who showed high risk of kidney problems between 1990 and 2004, as measured by elevated protein levels in urine, a condition called proteinuria.

The researchers also looked at blood sugar data from another 279 patients with more than three years of clinical observation available.

The team then compared average blood sugar levels before the study started with levels five years later.

The average pre-study blood sugar reading was 9.3 percent blood concentration, compared with 8.7 percent five years later. The normal target blood sugar level for diabetes patients is 7 percent or lower.

After 15 years, the risk of kidney problems was lower for patients whose blood sugar level dropped than for patients whose blood sugar levels went up (29 percent risk versus 43 percent risk).

Dr. Krolewski and his colleagues found that the difference in risk did not develop until a decade after onset of proteinuria.

He said in a prepared statement that this study showed “you have to improve glycemic control for a long period of time to see this effect among these patients.”

Study co-author Robert Stanton, MD, chief of the Kidney and Hypertension Section at Joslin, said, “There is a great need to find new approaches and new treatments to both prevent development of diabetic kidney disease and to slow progression.”

The authors of this study concluded that long-term blood sugar control is important in managing diabetes.

Further, they found that patients with proteinuria could postpone onset of diabetes-related kidney problems by controlling blood sugar levels.

This study was published online June 5 in the Journal of the American Society of Nephrology.

This research was funded by grants from the Joslin Diabetes Research Foundation.

The authors did not disclose any conflicts of interest.

Review Date: 
June 10, 2014