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Long-Term Diabetes Control Pays Off for the Heart
posted 04/22/04
New research confirms that good long-term glycaemic control
preserves cardiac autonomic function in type 1 diabetic patients.
A mean HbA1c of 8.4% or greater predicted cardiac autonomic dysfunction. 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 In Control.com: Diabetes Care 27 (4)
963-966.
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