Treatment of Type 1 Diabetes

Dividends from Tight BG Control…and More

Tighter Blood Glucose Control Leads to Longevity
Many Type 1 activists point out that insulin is not a cure. That’s because insulin therapy comes with a lot of negatives, including risk of death from hypoglycemia. There’s long been a debate over whether it was better in the long run to risk more bouts of hypoglycemia and achieve tighter blood glucose control, or to run high in one’s blood glucose levels and lower the hypoglycemia risk.

Now, a new study out of the University of Pittsburgh offers evidence that the heightened risk of hypoglycemia might be worth it. According to the Pittsburgh Post-Gazette, researchers tracked two groups of patients with Type 1 diabetes, those on a strict insulin regimen that kept their A1C around 7.0 and a control group with an A1C around 9.0, for 27 years. The researchers found that those on intensive insulin therapy had better long-term outcomes. They suffered lowered risk of long-term diabetes complications, like heart disease, stroke, kidney disease, and limb amputations. Those medical gains outweighed the downside of increased bouts of hypoglycemia, the researchers said.

It should be noted that this study began nearly three decades ago, at a time when people with diabetes on intensive insulin therapy had less reliable tools, like new-generation insulin pumps and continuous glucose monitors, to monitor their blood sugar levels and stave off hypoglycemia.

Blood Sugar Standards Tightened
The American Diabetes Association (ADA) has issued new standards for medical care for people with both Type 1 and Type 2 diabetes. Many of the standards focused on issues related to Type 2 diabetes, including new guidelines for statin use and body mass index (BMI) monitoring. However, there were new guidelines for people with Type 1 diabetes, as well, according to a report in Diabetes Care. These new guidelines included a new A1C goal for children and adolescents of 7.5 or less, and a recommendation that people with diabetes maintain pre-meal blood sugar levels of 80 to 130 mg/dL. The ADA also urged doctors to examine the feet of patients with prior history of foot issues at each visit to catch foot problems in the early stages.

Easier Access to Insulin in School
Schoolchildren in Tennessee will now have more options for insulin injections at school, thanks to a new state law that went into effect at the start of the year. Under the new law, school staff who are not nurses can be trained to administer insulin. The law will help deal with the perpetual chronic shortage of school nurses; many schools don’t have a school nurse, and many more share one nurse for several schools. School districts will have to opt in to allow staff to be trained to administer the injections. Tennessee joins 20 states and the District of Columbia in passing this type of legislation, according to a report in the the Tennessean.

More Psychological Support Needed
A new survey has found that a majority of people with diabetes in the United Kingdom who said they needed psychological support weren’t able to access it. A study of 3,845 people with diabetes by Diabetes UK found that 68 percent of those who said they needed psychological help weren’t able to find it. According to the organization, people with diabetes suffer twice the rate of depression than the average population.

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Craig Idlebrook is a past editor for Insulin Nation, Type 2 Nation, and Información Sobre Diabetes. He is now the community engagement and content manager for T1D Exchange.

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