| Long-term diabetes control pays
off for the heart
NEW YORK (Reuters Health) - People with diabetes are urged to keep
their blood sugar levels in check to avoid multiple complications
down the road. While that can be tiresome day in and day out, the
effort is rewarded in the long run, Norwegian researchers confirm.
They have found that good long-term glucose control by type 1 diabetic
patients preserves the automatic responses of the heart to varying
situations, while a lack of adequate glycemic control leads to poor
so-called cardiac autonomic function.
"Our findings confirm the important role of good glycemic
control in the functioning of the autonomic nervous system in type
1 diabetes and validate after 18 years our findings from 8 years'
observation in the Oslo study," the investigators write in
the medical journal Diabetes Care.
Dr. Jakob R. Larsen and colleagues from Ulleval University Hospital
in Oslo followed 39 patients with type 1 diabetes for 18 years.
For 14 of those years, the participants adhered to intensive insulin
treatment, based on studies showing that tight glucose control can
slow the development and progression of abnormal autonomic function.
Levels of glycosylated hemoglobin -- an indicator of glucose control
over a period of time -- were measured yearly, and the subjects
underwent a battery of tests widely used to assess cardiac autonomic
function, including heart rate responses to deep breathing, to being
tilted into various positions, and maximal exercise testing.
The investigators found that an average glycosylated hemoglobin
level of less than 8.4 percent over 18 years was "strongly
associated with preserved cardiac autonomic function." Conversely,
a level higher than that predicted impaired cardiac autonomic function.
For all the cardiac function tests, values stayed within normal
for participants with the lowest glycosylated hemoglobin levels
but were "pathological" in those with the highest levels,
Larsen's team reports.
Dysfunction of the cardiac autonomic nervous system increases the
risk of death in diabetic patients, the researchers note, but the
risk can be lowered by reining in blood glucose levels consistently.
SOURCE: Diabetes Care, April 2004.
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