Intensive Treatment for Type II Diabetes Patients Increases Median Lifetime by 8 Years

Highlights

• Intensive therapy for type 2 diabetes with microalbuminuria found to be effective.
• It increases median lifespan by 8 years.
• First cardiovascular event noticed only after 8 years.
• 30-50% reduction in complications in the eyes and kidneys.

Scientists carried out a long-term follow-up study in a Danish population to understand the importance of intensive treatment for type 2 diabetes patients who had microalbuminuria. The study revealed that intensive therapy for type II diabetes patients with albuminuria showed a significant increase in life span when compared with type II diabetes patients who received traditional methods of treatment. One of the two first authors of the study, Dr. Peter Gaede from The University of South Denmark says "The outcome of our study is very encouraging and emphasizes the need for early and intensified treatment of multiple modifiable risk factors for a poor prognosis of patients with type 2 diabetes."

Type II Diabetes

In patients with type II diabetes, insulin, that is responsible for the uptake of blood sugar into fat, liver and muscle cells, does not function well. This results in a build-up of blood sugar and an inability of the fat, muscle and liver cells to take up the blood sugar and to store it as energy.

This disease is gaining in incidence with many people affected. People who are overweight or obese are prone to diabetes and it is aptly called a lifestyle disease.

The build-up of blood sugar is called hyperglycemia and, initially, the pancreas will produce more insulin to lower the blood sugar but, over time, the production of insulin by the pancreas is lowered. The conditions that arise due to this are:

• Lack of energy in the cells
• Build up of sugar in the blood
• Increased blood lipids
• Increased aggregation of the platelets in the blood
• Increased blood pressure

These conditions could affect kidneys, eyes, heart and lead to classical symptoms of diabetes.

Symptoms of Type II diabetes

Diabetes is considered a silent killer as the symptoms are not very evident or can easily be mistaken for a common condition. The following are some of the symptoms of this disease

• Blurred vision.
• Frequent urination.
• Increased thirst.
• Increased hunger
• Fatigue
• Frequent infection of the skin and kidney that take time to heal.

Some patients with type II diabetes also excrete some albumin in the urine called microalbuminuria which, when left untreated, can increase the risk of cardiovascular disease and lead to premature death.

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Management of Diabetes

The primary goal in managing type II diabetes is to lower the blood sugar levels and as this disease is considered a lifestyle disease, there are changes to the lifestyle that are recommended. However, patients rarely adhere to these modifications which have motivated researchers to study the difference in treatment methodologies and to record the effect on the lifespan of the patients.

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Steno-2 Study

Steno-2 was a well publicized study that studied the effect of intensified treatment for diabetes with standard intervention strategies for a period of 8 years among people with type II diabetes and microalbuminuria.

Lead senior author of the study Dr. Oluf Pedersen says "During recent years international and national guidelines for improved care of patients with type 2 diabetes have generally adapted the experiences and knowledge gained from multiple single-risk factor interventions (e.g. treating blood glucose alone, blood lipids alone, or elevated blood pressure alone) and the previously reported intervention outcomes of the multifactorial Steno-2 study. In parallel and excitingly, recent epidemiological surveys now report on a decline in diabetes mortality in several parts of the world. The observations from the 21 years of follow-up of the Steno-2 study are another important contribution to justify an early, intensified, individualised and multifaceted care of patients with type 2 diabetes".

Development of Complication in Type II Diabetes Patients

In an earlier follow up of the Steno-2 study of type II diabetes patients with microalbuminuria, the study authors analyzed the effectiveness of intensive treatment strategies against the standardized strategies to understand the implication on heart, eyes, kidney, legs and the brain.

Dr. Jens Oellgaard the co-author of the study says about the result of the previous study "In previous reports from the Steno-2 study we have demonstrated the unprecedented efficacy of this structured multifactorial intervention where development of complications in the eyes, kidneys, legs, heart and brain is halved compared with conventional multifactorial treatment."

Difference in Lifespan

Individuals who have type II diabetes along with microalbuminuria have a lower lifespan and the researchers followed up on the Steno-2 study to identify difference in lifespan among patients who received intensive treatment and patients who received standardized treatment.

Intensive Treatment Group:

The study group that received intensive treatment benefited from the following:

• The study was conducted in a diabetes clinic
• Low fat and green diet
• Increased exercises that were conducted daily.
• Instructions provided to quit tobacco
• Drugs provided for
• Blood glucose
• Blood pressure
• Blood platelet
• Blood lipids
• Microalbuminuria

Conventional Therapy Group

The patients in this group were treated according to the guidelines prescribed by diabetes care. They received medical care from general practitioners and were referred to specialists when there was a need.

The study continued for 8 years and 160 patients in the intensive study group were made to follow the same guidelines for 13 years after that.

Results of the Study

At the end of 21 years from the start of the study, the following results were recorded:

• 38 patients in the intensive therapy group died
• 55 patients from the conventional group died
• Patients in the intensive therapy group lived a median of 8 years longer.
• The median time taken for the first cardiovascular event was found to be 8 years for patients in the intensive therapy group.
• There was a 30-50% reduction in the risk of complications to the eyes and kidneys among patients in the intensive therapy group.

This is a landmark study that will significantly improve prognosis of patients with type II diabetes and microalbuminuria. There have been many studies that have looked at diabetes management from specific angles like lifestyle modification and better medications, however, this study focuses on including all these aspects in providing effective therapy. This effective therapy improved lifespan as well as the quality of life by lowering the risk of a cardiovascular event and complications in the eyes and kidneys.

As senior author Dr. Hans-Henrik Parving adds "This long-term follow-up of the Steno-2 study demonstrates beyond any doubt the sustainability of the intensified and multipronged treatment approach of type 2 diabetes patients with microalbuminuria introduced by us more than 21 years ago. The benefits for the patients in terms of a major extension of life and a halving of new cardiovascular complications speak for themselves.”

References:

1. Type 2 Diabetes Facts - (http://www.diabetes.org/diabetes-basics/type-2/facts-about-type-2.html)
2. Type 2 Diabetes - (https://medlineplus.gov/ency/article/000313.htm)

Source-Medindia