Thursday, January 27, 2005
Study finds smoking cessation and blood pressure reduction may help juvenile diabetics.
For decades, people with so-called juvenile diabetes have been told that controlling their blood sugar was all they could do to prevent nerve damage that can lead to the amputation of a foot or leg.
But a large new British study suggests they should follow the same advice given to other diabetics: Don't smoke, and watch your weight and blood pressure.2
These heart disease risk factors were almost as important as blood-sugar levels in predicting which diabetics would develop nerve problems.
In light of the findings, diabetes experts said cholesterol-lowering statin drugs and other heart disease treatments should be studied to see if they can help stave off or slow the progression of nerve damage in diabetics.
Of the 18 million Americans who have diabetes, about 5 percent to 10 percent have Type 1, sometimes called juvenile diabetes, though it can strike at any age. It occurs when the body cannot make enough insulin, the hormone needed to convert food into energy.
It differs from the more common Type 2, which is linked to obesity and occurs when the body cannot use the insulin it makes. Type 2 diabetes can be prevented or delayed by losing weight, eating a healthy diet and exercising.
But those steps were not thought to do much to prevent complications in Type 1 patients.
Nerve damage is a painful and disabling complication caused by poor circulation in the hands, arms, feet and legs. A third or more of Type 1 diabetics develop serious nerve damage, and many undergo an amputation.
British researchers selected 1,172 Type 1 patients throughout Europe and monitored their smoking habits, body weight, blood pressure, and cholesterol and triglyceride levels over seven years. Nearly a quarter of them developed nerve damage during that time.
After adjusting for how well patients' blood-sugar levels were controlled, scientists found an apparent connection between nerve damage and risk factors for heart disease. For example, patients who had high blood pressure were twice as likely to develop nerve problems.
The study, led by Dr. Solomon Tesfaye of the Sheffield Teaching Hospitals in England, appears in today's New England Journal of Medicine.
"It emphasizes that you have to treat the whole patient," said Dr. Martin Abrahamson, acting chief medical officer of the Joslin Diabetes Center in Boston, who was not connected to the study. "You can't just treat the glucose. You also have to look at all the cardiovascular risk factors."
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