The effect of long-term intensified insulin treatment on the development of microvascular complications of diabetes mellitus

Article Abstract:

Some complications of insulin-dependent diabetes mellitus may be avoided by an intensive treatment program that includes extensive patient education. Of patients with poorly controlled diabetes, 48 patients received an intensive insulin treatment and 54 received the standard insulin treatment (the control group). The intensive treatment protocol involved regular and continuous patient education about the nature of diabetes and the interpretation of blood glucose levels. The patients in the control group continued with their usual insulin routines. Over an eight-year period, only one patient in the intensive treatment group developed kidney disease compared to nine in the control group. Retinal disease developed in 12 patients in the intensive treatment group and 27 in the control group. However, retinal disease requiring treatment was equally prevalent in both groups. Nerve transmission studies revealed that nerve damage progressed more slowly in those in the intensive treatment group than those in the control group.

Type 1 diabetes

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New understanding and treatment of diabetic neuropathy

Article Abstract:

Medical researchers are focusing more attention on diabetic neuropathies, or nervous system disorders. Most diabetes patients develop a neuropathy, but usually after having diabetes for many years. Diabetic neuropathies often begin in the legs and feet, and may progress without symptoms. The same types of neuropathies may develop in non-diabetic patients, but the frequency is not known. Diabetic neuropathies usually develop after years of hyperglycemia, and may be caused by metabolic changes. Good diabetic control may prevent or lessen the severity of these neuropathies. Symptoms such as pain may be caused by overactivity of nerve cells. Patients with pain may need treatment with pain relievers, antidepressants or sedatives, and emotional support. Symptoms such as muscle weakness, loss of feeling and autonomic nervous system dysfunction are caused by under-activity of nerve cells. Patients with these symptoms may need to prevent obesity, inspect their feet daily for injury and avoid high-risk activities.

Editorial

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Prevention and treatment of the complications of diabetes mellitus

Article Abstract:

The best way to prevent the three major complications of diabetes is to control blood glucose levels. Increased blood glucose concentrations affect the retina of the eye, the kidneys and the nervous system. The complications are believed to be a result of excess glucose and its metabolic products. The 10-year Diabetes Control and Complications Trial has shown that proper glucose control can reduce the risk of complications. Since effective glucose control is more important before complications develop, every diabetic patient should have an annual eye exam. Aspirin and other antiplatelet drugs and laser surgery can be effective in treating retinopathy. Antihypertensive drugs such as ACE inhibitors, glucose control and dietary protein restriction can reduce the risk of diabetic nephropathy, or kidney disease. Nervous system disorders can be treated with tricyclic antidepressants, topical capsaicin, metoclopramide, erythromycin and cisapride.

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