Re: Why Do Some Diabetics Escape Complications?

On Jan 22, 5:56 pm, ray <r...@xxxxxxxxxx> wrote:
On Sat, 22 Jan 2011 16:47:51 -0600, outsider wrote:
On 1/22/2011 3:01 PM, Kurt wrote:
http://www.medicalnewstoday.com/articles/214485.php

(excerpt)

"The majority of diabetics will over time develop severe or fatal
complications, but 10 - 15 per cent never do. They are the ones we are
interested in in the PROLONG study", explains Valeriya Lyssenko, who
along with Peter Nilsson, both from Lund University Diabetes Centre,
leads the PROLONG study.

Is this report saying that 10 to 15 percent of diabetics die of
non-natural causes?

I wonder how they selected people to study. At what point does a
diabetic "never" develop severe or fatal complications? "-)

<http://www.sciencedaily.com/releases/2011/01/110121065753.htm>

According to the science daily article (that seems to have been a
reprint of a news release) they selected individuals with a 30 year
history of diabetes without serious complications based on the theory
that anyone who survived that long with no significant complications
isn't likely to develop any after that period of time.

For the "problem patients" they chose individuals with a 15 year history
of the disease, with problems.

"Today there are approximately 12 000 people in Sweden who have had
diabetes for more than 30 years; of these, 1 600 have had it for over 50
years."

It looks to me like only 13% of diabetics who have a 30 year history
manage to live another 20 years. Knowing more about what killed off that
87% is a set of statistics that interests me.

"'About half of these diabetic veterans do not have major complications..
Two thirds of those who have had diabetes for more than 50 years have
escaped complications. Clearly they are different and we want to find
out what it is that protects them,' says Valeriya Lyssenko."

I expect the answer is absurdly simple: those who maintain good control
of their BG don't develop complications - those who don't, do.

The DCCT showed that average bg == A1C is very strongly related to
microvascular complications.

The UKPDS did the same.

They have beautiful graphs that are very convincing for the
microvascular complications.

But note that they did not find any magic bg number below which the
microvascular complications go away. Sound bites from UKPDS
http://care.diabetesjournals.org/content/25/suppl_1/s28.full : There
was no evidence of any glycemic threshold for any of the microvascular
complications. [...] No glycemic threshold for [cardio] complications
above normal glucose levels was evident.

And look at the DCCT graphs, risks for microvascular complications go
down for lower A1C's, but the risks never go away.

But a lot of the complications (especially cardio) are only loosely
related to bg, and even the best controlled diabetics are still
enormously likely to have heart problems compared to the general
population.

Sound bite from UKPDS, http://care.diabetesjournals.org/content/25/suppl_1/s28.full
: "No significant effect of lowering blood glucose on cardiovascular
complications was observed."

There was some correlation between intensive bg control and
cardiovascular issues found in the DCCT and followup, but not nearly
as clear-cut as the microvascular complications.

What that means as better bg control becomes the norm, is that we are
entering an era where diabetics don't go blind and die of gangrene-
infected limbs and kidney failure, but instead die of heart disease.

To solve the cardio puzzle, the investigators have to start digging
way deeper than just bg numbers, and that's what I see them doing with
these long-term-survivor studies.

Tim.
.

Relevant Pages

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