By Linda Cohen, RN, MSN, MPH CDE

“You need to control your diabetes better!”

Sound familiar? Ever wonder why your healthcare provider advises you to aim for improved control of your diabetes? Are you curious about why improving your diabetes management can improve your health or lessen your risk of developing diabetic complications? Diabetes can impact your kidney function. You must manage your diabetes in order to improve your quality of life and maintain an active lifestyle.

Let’s talk evidence or as they say in the medical community… “Evidence Based:”

The Diabetes Control and Complications Trial (DCCT) was a famous study that included 1,441 people with type 1 diabetes. Remember 1983? Diabetes care was much different then. The DCCT ran from 1983 to 1989. It included people with type 1 diabetes (ages 13 to 39 years of age). One of the two groups studied, the intensive group, tried to keep their glucose levels as close to normal as possible by injecting insulin at least three times a day or by using an insulin pump. Study subjects also checked their blood glucose (sugar) several times a day and were guided by a healthcare team to help them. The second group studied, the conventionally treated group (meaning usual treatment was continued), received one or two injections of insulin a day guided by tests of urine or blood glucose daily (this was more or less routine management of diabetes at that time).

Important Findings:

1. Those in the intensive glucose control group greatly reduced the rate of eye, nerve, and kidney damage.

2. The average AIC (a blood test, that measures your blood sugar levels over the past 2-3 months) in the intensively treated group was 7 percent and 9 percent in the conventionally treated group. (After the study, those in the conventionally treated group were encouraged to follow the practices of the intensively treated group.)

3. Long lasting value. In June, 2005, it was reported that 1,375 of subjects in the original DCCT continued to be observed. Encouragingly, the original intensively treated group had less then half the number of heart attacks, stroke, angina and coronary artery disease when compared to the conventionally treated group. Study investigators concluded that when “tight” control is achieved, it can have lasting results.

4. Studies in the United States and abroad have found that improved glycemic control benefits people with either type 1 or type 2 diabetes. In general, every percentage point drop in A1C blood test results (e.g., from 8 to 7 percent) reduces the risk of microvascular complications (including the advancement of kidney disease).

Did you know that people with diabetes are about two to four times more likely to develop heart disease or have a stroke than people without diabetes? The results of a patient survey showed that more then 2/3 of the people were not aware of this increased risk. Also, many surveyed were not aware that high blood pressure and high cholesterol, conditions common in people with diabetes, can add to their increased risk for heart disease and stroke.

According to the American Diabetes Association, diabetes management requires more than lowering blood glucose (sugar). A diabetes care plan should also address lowering blood pressure and cholesterol, quitting smoking, and taking aspirin and other medicines to reduce one’s risk for heart attack and stroke.

Detecting and treating diabetic eye disease with laser therapy can reduce the development of severe vision loss by an estimated 50 to 60 percent. Comprehensive foot care programs can reduce amputation rates by 45 to 85 percent. Detecting and treating early diabetic kidney disease by lowering blood pressure can reduce the decline in kidney function by 30 to 70 percent. Treatment with ACE inhibitors and angiotensin receptor blockers (ARBs) are a special class of blood pressure medications and have been shown to be effective in reducing the decline in kidney function more than other blood pressure-lowering drugs. Some examples of these medications include enalapril, lisinopril, captopril and losartan.

What else can you do?

Meet with a certified diabetes educator. A certified diabetes educator (CDE) is trained to help you learn about diabetes and make adjustments in diabetes care. A diabetes educator can give you a better understanding of the biology of diabetes, help in fitting diabetes care into your lifestyle, and teach you about medication and glucose control. If your doctor doesn’t refer you to a diabetes educator automatically, ask about it. Your doctor can probably recommend a diabetes educator in your area or call the American Diabetes Association at 1-800-DIABETES or call American Association of Diabetes Educators at 1-800-338-3633, or visit www.Diabeteseducator.org.

Meet with a registered dietitian (RD). A dietitian is an expert in food and nutrition. He or she can help you create and stick to a healthy eating plan. It’s a good idea to consult a dietitian at least once a year to get help in adapting your eating plan or whenever your diabetes treatment changes. You can get more information by calling the American Dietetic Association at 1-800-877-1600, or visit www.Eatright.org.

Information from this article was obtained from the following organizations. Visit their website or Telephone them for more information.

National Diabetes Information Clearinghouse
Phone: 1–800–860–8747, www.diabetes.niddk.nih.gov

National Diabetes Education Program
Phone: 1–800–438–5383, http://ndep.nih.gov

American Diabetes Association
Phone: 1–800–342–2383, www.diabetes.org

Linda Cohen, RN, MSN, MPH CDE, is the AAKP Brooklyn Mildred Barry Friedman
Chapter President and Assistant Director of Nursing, SUNY, Downstate Medical Center in Brooklyn, NY.

This article originally appeared in the June/July 2006 issue of Kidney Beginnings: The Magazine, Vol. 5, No. 2.

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