Tight control of blood glucose in type 1 diabetes is not entirely a matter of diet, exercise and medications, say researchers who reported Saturday that they've found four genes related to glycemic control in type 1.
Two of these genes also affect the risk for kidney, eye and cardiovascular complications of diabetes and one influences the rate of hypoglycemia, or low blood glucose, said lead author Andrew D. Paterson, Senior Scientist in the Program for Genetics and Genome Biology at the Hospital for Sick Children in Toronto.
Paterson and colleagues sifted through data from the Diabetes Control and Complications Trial (DCCT), an NIH-sponsored study begun 25 years ago that compared intensive control of blood glucose to conventional control in 1,441 people with type 1.
The intensive arm of the study involved:
- at least three insulin injections a day or use of an insulin pump
- at least four glucose checks a day, aimed at bringing A1C levels to 6% or less.
The conventional arm required:
- only two insulin injections
- blood tests which resulted in A1C levels of 9% or more.
Sixteen Years Ago
Results of the DCCT reported in 1993 showed intensive control drastically reduced the eye, nerve and kidney damage that are often long-term complications of diabetes. A follow-up showed that intensive control also reduced the risk of heart disease.
Results of the DCCT reported in 1993 showed intensive control drastically reduced the eye, nerve and kidney damage that are often long-term complications of diabetes. A follow-up showed that intensive control also reduced the risk of heart disease.
Today's News
In the genetic study reported today, researchers conducted genome-wide studies, comparing gene positions of interest in each of the two study arms.
Dr. Paterson said in a press release that the information gives insight into the mechanisms influencing glycemic control in type 1, but "it is important to remember that the overall influence of genes is small and may vary from person to person and, perhaps, in response to behavior.''
That means people are still on the hook when it comes to their actions, he said.
"This finding does not give people with diabetes the freedom to slack off on their careful nutrition, exercise and medication regimens," he said, "because behavior clearly plays the major role in glycemic control."
Dr. Paterson also said the findings may ultimately help identify people at risk for poor glucose control and complications of diabetes, so steps could be taken to avert those problems.
In the meantime, the study may inform design and analysis of other genetic studies and point to new research directions.
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