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Re: [IP] Study shows some T1's don't get complications



Sorry, this is long, but several people have alluded to it so here it is.
 Seems to depend on factors other than just A1C.
Mary

http://www.businessweek.com/lifestyle/content/healthday/651365.html

<http://www.businessweek.com/lifestyle/content/healthday/651365.html>Some
Type 1 Diabetics Seem Shielded Against ComplicationsIn one group that had
diabetes for 50 years, many never developed expected problems, study finds

*By Serena Gordon*
*HealthDay Reporter*TUESDAY, March 29 (HealthDay News) -- While
complications from type 1 diabetes are common, they aren't inevitable. New
research suggests that some people with the disease apparently have an
inherent protection against serious complications, such as eye, kidney and
heart disease.[image: HealthDay/ScoutNews LLC] <http://www.healthday.com/>

In a group of people who'd had type 1 diabetes for more than 50 years,
nearly 43 percent remained free of serious eye disease, while about 87
percent never developed kidney disease, nearly 40 percent were free of nerve
damage and more than 50 percent were free of cardiovascular disease,
according to the study.

"We have identified a group of people who can clearly live well with
diabetes for a long time," said the study's senior author, Dr. George King,
chief scientific officer at the Joslin Diabetes Center in Boston. "Now,
we're in the process of finding out why. In the meantime, if you have type 1
diabetes, try to control your disease. The reason that most of them eluded
the problem of complications is that they manage their disease pretty well,"
said King.

But, this study found that even in this group of people who -- on average --
maintained good blood sugar control, some developed complications, while
others appeared to have some sort of protection against them.

Results of the study are published in the April issue of *Diabetes Care*.

Almost 26 million Americans have diabetes, according to the U.S. Centers for
Disease Control and Prevention (CDC). About 5 percent of those have type 1
diabetes, the CDC estimates. Type 1 diabetes is an autoimmune disease in
which the body's immune system mistakenly attacks the insulin-producing
cells in the pancreas. Insulin is a hormone that's necessary for the body
and brain to be able to use the sugars found in carbohydrates as fuel.
People with type 1 diabetes must take replacement insulin, through
injections or an insulin pump, all of their lives.

Without insulin, or without enough insulin, the body can't use blood sugar
for fuel, and the sugar builds up in the bloodstream. Long-term high blood
sugar levels can cause a number of serious problems, including diabetic
retinopathy in the eyes, kidney damage and possibly failure, nerve problems
and heart disease.

Previous research has shown that good control of blood sugar levels can help
prevent these complications. But, it's difficult to keep blood sugar levels
low without going too low (hypoglycemia), a potentially dangerous condition
itself.

For the current study, the researchers assessed complications in a group of
351 people with long-standing type 1 diabetes. These people were part of a
group known as the diabetes "medalists." They've lived for more than 50
years with type 1 diabetes, and were initially diagnosed at a time when good
blood sugar control wasn't really possible because blood glucose meters and
other technologies that help people live with diabetes today just weren't
available then.

The average A1C level in this group was 7.7 percent. A1C is a measure of
blood sugar control over several months. People without diabetes have levels
under 6 percent.

Overall, King said, about 35 percent of the medalists didn't develop any
serious problems related to their diabetes. "There's something in those 35
percent that protects them from diabetic eye, kidney, nerve and heart
disease," said King.

And exactly what that protective mechanism might be isn't yet known. It's
hard to create a control group for comparison to the unusual group of
diabetes survivors, the study noted. In addition, the protective mechanism
may be different for microvascular complications (such as kidney and eye
disease) and macrovascular complications (such as heart disease), according
to background material accompanying the study.

One potential reason is suggested by a certain combination of substances
called advanced glycation end products (AGEs), which the study found were
7.2 times more common in people with complications. AGEs develop in the body
after long-term exposure to high blood sugar levels.

This particular combination of AGEs (high plasma carboxyethyl-lysine and
pentosidine) was linked to complications, but other AGE molecules appeared
to have a protective effect -- an exciting finding the researchers said may
lead to new biomarkers for protection against complications.

And there may be other ways to keep the problematic AGEs under control.

The author of an accompanying editorial, Dr. Aaron Vinik, noted that a
receptor for AGE called sRAGE is lacking in people with complications. "When
you have diabetes early on, you have about a 50 percent reduction in sRAGE.
People who develop serious complications have an 85 percent reduction in
sRAGE. So, the best predictor of longevity and freedom from complications
may be a good sRAGE mechanism," explained Vinik, who is the director of the
Eastern Virginia Medical School Strelitz Diabetes Center in Norfolk, Va.

Vinick also pointed out that many of the drugs that are commonly prescribed
today to help people with diabetes live longer and better lives -- such as
ACE inhibitors to control their blood pressure and statins to control their
cholesterol levels -- raise sRAGE levels.

Both King and Vinik said that once researchers figure out exactly which
substances are at play in those who are protected from diabetes
complications, the findings could lead to ways to screen for those most at
risk of complications, and potentially to a treatment that could help
prevent complications.

King said that while the researchers figure out how to better protect people
with diabetes from complications, good blood sugar control remains the
cornerstone of diabetes management. He added that the medalists as a group
tended to be very proactive and involved in their diabetes care.

"In general, the medalists control their disease rather than letting the
disease affect their life patterns. This is a group of patients that manages
things rather than let things manage them," said King

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