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Factors in Long Term Survival of T1Ds

tim2000s

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Rather than fill up another thread with this discussion I thought it warranted a new one. This article is very interesting and I found some of the key points in it to be quite reassuring:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4058732/ - Why do some T1Ds live so long?

Part of the summary says:

However, while a number of publications have associated poor long term glycaemic control with an increase in both all-cause mortality and CVD in those with type 1 diabetes, it is apparent that good glycaemic control alone cannot explain why some patients with type 1 diabetes avoid fatal CVD events. Lipid disorders may occur in those with type 1 diabetes, but the occurrence of elevated high-density lipoprotein-cholesterol is positively associated with longevity in this population. Non-renal hypertension, by itself is a significant risk factor for CVD but if adequately treated does not appear to mitigate against longevity. However, the presence of nephropathy is a major risk factor and its absence after 15-20 years of diabetes appears to be a marker of long-term survival. One of the major factors linked with long-term survival is the absence of features of the metabolic syndrome and more specifically the presence of insulin sensitivity. Genetic factors also play a role, with a family history of longevity and an absence of type 2 diabetes and hypertension in the family being important considerations.

Quite an interesting indicator in this context, and my 27 years thus far with no kidney issues is somewhat reassuring! Worth a read at any rate...
 
Yes, I was actually told that good news about twenty years ago by a doctor, when I admitted how much I feared kidney failure. He told me that after 7 years, if you haven't got it already you probably won't get it. And after 14 years your chances of getting it are virtually zero. However, he looked pretty wary when he told me, and I decided not to take it as licence to go crazy! I think he was worried it might have that effect.


I mean, if you look at the table of positive factors, you get:

  • Reasonable (not necessarily ideal) glycaemic control
  • High HDL-cholesterol levels
  • Low daily insulin requirements (“insulin sensitive”)
  • Normal body weight
  • Non-smokers
  • Lower blood pressures
  • Microalbumin negative after 15-20 yr of diabetes
  • Family history of longevity

For me this study confirms that T1 and T2 are NOT the same disease at all. They share a symptom. But T2 is insulin resistance and T1 is not. Everyone here knows I am always banging on about how important exercise is for Type 1s, and this study absolutely confirms it. The lowish TDDs (around 30 units per day) are cited, plus the fact that for longevity, you really mustn't get 'double diabetes' aka T1+ insulin insensitivity. I think the LCHF stuff on here is a complete red herring for T1s, takes up far too much space and has no evidence base behind it at all for T1s.

That doesn't mean that I think T1s should be on the sugar rollercoaster. I understand why people want flat profiles. It simply feels better. But it is more important for T1s to focus on keeping their insulin sensitivity. High blood sugars cause inflammation - damage - to blood vessels and organs. However, a Mediterranean diet and exercise are anti-inflammatory, so we can "push back" and even gain ground. LCHF with an exercise regimen is great. If it's an excuse for no exercise, it seems highly risky to me for a T1.

The other interesting article I read today, which I believe is relevant, is posted in News
http://www.diabetes.co.uk/forum/thr...abetes-related-coronary-heart-disease.104108/

I regularly have a very low Vitamin D level - and that is strongly associated with heart disease (and, i think i remember cholesterol problems) and I have to supplement. And lots of Type 1s have low Vitamin D. So I think we should be tested for it regularly.

As for the rest, it answers my questions about my own medical history and why it has "worked" for me. My only issue is that my HDL is bang on, my trigs are bang in the middle of the target range, but my LDL is high and I'm not sure what to do about that (or even what it really means). The study doesn't cite it at all. Maybe it doesn't matter?

Edited to add: The study doesn't say the long-living T1s have NO complications - another reason not to go crazy and feel "off the hook."
 
I have been T1 for over 54 years,with only a couple of very minor complications and no kidney problems,bar for the first 8 or 9 years when I abused my diabetes.For the most part of my life I have maintained pretty good control,that's not to say I haven't fallen of the rails for a day or two every so often,as I like a pint.I have 4 wonderful children and my rock,my wife.I worked until I was 65 and I was Construction Director with one of the largest international construction companies and I have worked all over the world.I can tell you for sure that I will not this bloody horrible disease get me.
 
Weren't you/arent you a keen football player? I think I remember you saying it. Anyway, the study says that once you make it this far, you actually don't need to be as tightly controlled as in the beginning. So it hasn't got you!
 

It's posts like yours @yingtong that many of us take inspiration from, long may your good progress continue
 

Kudos to you, a role model for me. 3.5 yrs after diagnosis I'm lapsing in my control after the initial education and strict discipline.
 
JRW said:
Kudos to you, a role model for me. 3.5 yrs after diagnosis I'm lapsing in my control after the initial education and strict discipline.
Click to expand...

JRW,please jump back on the band wagon and get your control back,I know it's easier said than done,but,if you do,you will go on to enjoy your life.It's much easier to live with good control than bad.Good luck to you and a very long life.
 
RuthW said:
Weren't you/arent you a keen football player? I think I remember you saying it. Anyway, the study says that once you make it this far, you actually don't need to be as tightly controlled as in the beginning. So it hasn't got you!
Click to expand...

RuthW,yes I used to play semi-professional football in my younger day,I personally disagree with the study and you need to keep good control all of your life,and I will continue to do so.
 
yingtong said:
I personally disagree with the study and you need to keep good control all of your life,and I will continue to do so.
Click to expand...

Yes, the study is NOT saying you can slack off with your control. It is a long-term study which shows, as far as possible, what are the actual physical characteristics of people who survive long term with T1. Some of those factors are outside our control (the longevity of our relatives, for example, whether we have a family cholesterol problem is another). Some of the factors are inside our control (=reasonable control of blood sugar, insulin sensitivity, etc).

I pointed out a few times above that this study does NOT mean we can all relax and let our diabetes go hang.

Also, surviving 50 years doesn't mean quality of life, necessarily. If you are blind and have cognitive impairment, for example, it's like that saying, "If you give up wine, women and song, you don't actually live longer, it just feels like it!" For T1s, it may be similar; if we don't keep good control all our lives, we may have a very painful and debilitated old age.

But I DO think it is worth noting that a very low HbA1c was not shown to be an advantage. But only interesting, not conclusive. I note that the researchers did not put the control of blood sugar at the bottom of the list. It is still at the top.

But we know that both DKA and hypoglycaemia can be fatal to Type 1s. Maybe once more people are kitted out with CGMs, we can see people surviving long-term without such high HbA1c readings. But it does tell us why doctors are cautious about lowering HbA1c too much. And why they are not concerned about T1s staying "in range" while actually doing sports. Being a bit high before is clearly offset by the advantage of the insulin sensitivity gained.



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Last edited by a moderator:
Hi RuthW,I have maintained aHbA1c of between 5.0 and 5.4 for the past 30 odd years and I believe that keeping blood/glucose as near to normal person has allowed me to live my life as near to normal as a diabetic can be.Yes,I do use a CGM in conjunction with my pump.this allows me to understand how foods effort me,thus give me better glycemic control,also I live a very active lifestyle especially with 7 grandchildren.I have always keep accurate records,which also helps,as I often refer back to these.I have my gold medal and intend to collect my platinum one.Good luck.
 
Yes, and you are already a 50+ years survivor, aren't you? So the next time this type of research is done, there may be some people with better HbA1cs. I doubt if there will ever be 50+ survivors with high insulin resistance ( and high TDD).


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That's a really interesting article. I have been wondering for some time why insulin resistance has not been eliminated by natural selection. I thought it must have some purpose. I think it goes a bit far in some speculation (all the narrative about seasons and so on has limited application around the equator!) but the parts about tissue-specific IR are very useful indeed.


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