In This Chapter
^ Protecting the eyes and kidneys from diabetes-related diseases ^ Shielding the nervous system ^ Defending the heart
^ Considering other potential complications
7 his chapter is the bad news-good news chapter. The bad news is that if you don't manage your diabetes or your child's diabetes properly, you or your child will suffer one or several of the serious long-term complications that I discuss here. The good news is that everything is in place now to prevent this from ever happening; in Part III, I tell you what you need to know about controlling and treating type 1 diabetes.
The long-term complications in this chapter take between 10 and 20 years to develop. Long-term complications of type 1 diabetes (which I abbreviate T1DM) are divided into microvascular complications and macrovascular complications:
1 Microvascular complications affect the tiny blood vessels that you wouldn't ordinarily see without magnification. They consist of
• Retinopathy, or eye damage
• Neuropathy, or nerve damage
The Diabetes Control and Complications Trial (DCCT) was published in The New England Journal of Medicine in September 1993. This study of patients with T1DM proved that control of the blood glucose would prevent complications from developing. Also, the study showed that the progression of complications that had already developed could be slowed.
Researchers divided patients involved in the study into two groups: 730 patients were treated with the usual treatment of the time, consisting of one or two insulin injections daily, and 711 patients were given intensive treatment with either three or more shots of insulin daily or an insulin pump. After six and a half years, the study was terminated because the results were so clear:
I It was possible even in 1993 to achieve a level of blood glucose control that would prevent long-term complications in T1DM.
I Intensive therapy reduced the risk of retinopathy (eye disease) by 76 percent compared to conventional therapy. In patients who already had retinopathy, intensive therapy reduced the risk that it would progress to a severe form by 47 percent and reduced the need for treatment by 56 percent.
I Intensive therapy reduced the risk of development of microalbuminuria, a early sign of diabetic kidney damage, by 43 percent.
I Intensive therapy reduced the risk of nerve damage due to diabetes by 69 percent.
After the DCCT, no one could doubt that persistently high blood glucose acts as a poison in the body. Furthermore, the patients in the DCCT continue to be followed. Fifteen years after the study, the group that had intensive therapy has a sustained benefit; they continue to have reduced eye damage, occurrence of kidney diseases, and nerve damage.
In this chapter, I discuss both microvascular and macrovascular long-term complications of T1DM as well as other diseases that occur more often in people with T1DM and complicate the treatment of T1DM because of the fact that autoimmune diseases tend to occur together.
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