Tight Rein On Diabetes

By Anastasia Toufexis

When coping day after day with a chronic disease, patients generally want the treatment to be as simple as possible. But in the case of diabetes, simplicity is not the best policy. On Sunday the National Institutes of Health announced the results of a 10-year, $165 million study that proved that the most effective treatment for severe diabetes is a complex, time-consuming regimen to control blood-sugar levels tightly. Patients who make that extra effort will lower their risk of suffering blindness, kidney failure or many other complications of diabetes.

Diabetics are unable to produce enough insulin, a natural hormone that enables cells to absorb sugar. In so-called Type I diabetes, which most often strikes in childhood, patients lose the ability to make any insulin. For these cases, the standard daily treatment is a blood test and one or two self- administered insulin shots. The shots keep the patient alive and well, but blood-sugar levels swing sharply, from relatively low after a dose of insulin to much higher before the next injection. These fluctuations gradually cause damage to the body's organs.

For decades researchers have argued that stricter control of blood sugar & would reduce complications, and the NIH study, which monitored 1,441 patients, was designed to test that proposition. While roughly half the subjects received the standard treatment, the others were put on an intensive program: tests of sugar levels at least four times a day, three or more insulin shots and a special diet. The results were striking: over the 10 years, the group receiving stricter treatment suffered about half as much eye and kidney damage as the other patients did.

The new regimen has its own risks. As the number of insulin shots increases, so does the chance that patients will accidentally push their blood sugar too low -- a condition called hypoglycemia, which can lead to seizures and death. Most diabetics recognize the early symptoms, such as light-headedness, and eat something sweet before the effects become dangerous. But because of the risk of hypoglycemia, the intensive treatment program is not recommended for children under seven and elderly people who are frail.

For the large majority of Type I diabetics who can carefully control sugar levels, the rewards will be well worth the bother. Says Tom Boyer of Washington, who has been on the strict regimen for several years: "The better you take care of yourself, the better you'll be down the road."

With reporting by Dick Thompson/Washington