viviennem said:
At last, somebody thought to ask the question! I wonder if the answer will be - "kept tight control of their bg levels"?
Not if it reflects previous studies which have studied the survivors of 50 years with T1. Not until relatively recently was Hba1c tested and the tools for strict control weren't available when these people developed diabetes. The studies done to date though are all on T1 and don't necessarily apply to T2.
I don't know if the study mentioned in the link will cover T2 either as until recently you wouldn't have found many people diagnosed with T2 at an age to have a life expectancy of more than 30 years.
In the
Joslin study, there was no difference between the HbA1c and previous control history of those with and without complications (average was
7.6%) at time of testing. In the
Paris study, the survivors had had an average of 35 years before any complications had developed (and even then very few had 'severe' ones. Their mean Hba1c was
8.6% and only 10% were below 7%. In a small
UK study of 10 people (1993)who had had diabetes for an average of 67 years , 4 had some evidence of complications but none had lost sight, needed dialysis or suffered amputation. These people had an average HbA1c of
10%!
In the
Joslin study the survivors had
normal BMI (average 25),
high HDL (average 1.84mmol) and
low insulin doses(average 0.52 u per kilo).
When they looked at factors that correlated with complications :age, diabetes duration, age at onset of diabetes, A1C, BMI, total cholesterol, and LDL cholesterol did not differ significantly between groups or for each microvascular complication.
Those people with complications tended to have higher triglycerides,take higher doses of insulin and strangely in the case of nepthropathy have lower hbA1cs.
The
Paris study also found that their survivors had normal BM1s, higher HDL, and took an average of 0.52 u insulin. They also tended to be active with most doing at least 30 min of exercise a day, had social lives (visits to theatre, restaurants etc) and had worked full time .. 40% were still working.
In the
UK study only one subject was obese (over BMI 30)
Recently the Joslin study has shown that 67% of it's survivors have some residual insulin production and that there is evidence of continuous beta cell renewel and death.
So my take on the results I've read (and summarised only briefly) is that a low HbA1c is probably a good thing(from other studies) but its equally important to keep a healthy weight, be active and have a good lipid profile with higher HDL and lower triglycerides... and be lucky enough to have some residual insulin production.
http://onlinelibrary.wiley.com/doi/10.1 ... 029.x/full
http://onlinelibrary.wiley.com/doi/10.1 ... 8/abstract
http://www.springerlink.com/content/221 ... lltext.pdf
http://care.diabetesjournals.org/content/30/8/1995.full
