SummaryWe have investigated the effect of long-term strict glycaemic control on peripheral and autonomic nerve function in 45 IDDM patients (age 18-42 years, diabetes duration 7-23 years) without clinical signs of neuropathy or other neurological disease. They were randomly assigned to treatment either with continuous insulin infusion, multiple injections (4-6 times daily), or conventional treatment (twice daily) for 4 years and followed prospectively for 8 years. Motor and sensory nerve conduction velocities were measured at the start and after 8 years. Autonomic nerve function tests were performed only once, after 8 years. A significant reduction of nerve conduction velocity was observed during 8 years in patients with mean HbA1 more than 10% (n = 12, group mean 10.9%, range 10.1-13.2%) compared to patients with HbAI less than 10% (n = 33, group mean 9.0 %, range 7.5-9.9 %). Change of motor nerve conduction velocity in the peroneal nerve was: -4.8 + 4.9 (SD) vs -2.2 + 5.3 m/s (p < 0.01). Change of motor nerve conduction velocity in the posterior tibial nerve was: -6.8 + 5.7 vs-3.9 +_ 5.1 m/s (p < 0.05). No significant changes were observed in the ulnar nerve. Change of sensoric nerve conduction velocity in the sural nerve was: -8.9 + 8.0 vs -4.6 + 5.3 m/s (p < 0.05). Multiple regression analysis showed that a change in HbA1 of 1% resulted in a 1.3 m/s change in nerve conduction velocity during 8 years. A significantly lowered heart-rate variation during deep breathing (p < 0.05) and heart-rate response to standing (p < 0.01) was found in patients with HbA1 more than 10 % compared to patients with HbA1 less than 10 %. This study confirms that the long-term lowering of blood glucose retards the deterioration in nerve conduction velocity observed in the diabetic nerve. [Diabetologia (1994) 37: 579-584]
Conventional insulin treatment used during the latter part of this century has been unsuccessful in giving most patients with insulin-dependent diabetes mellitus (IDDM) a long normal life. During the last 10 years, however, our knowledge has improved dramatically. We concluded in 1987: "The accumulating evidence for the relationship between blood glucose control and the development and progression of diabetic microangiopathy, and the demonstration that early microangiopathy responds favourably to nearnormoglycaemia, calls for action to improve the care for diabetics. The question regarding blood glucose control is not in essence 'why', but 'how'?" [1]. This statement was based on the results from several Scandinavian trials which started 10-12 years ago [1][2][3][4][5][6][7]. Since then further evidence has strengthened the basis of the above conclusion, particularly results from the Stockholm study [8] and the Diabetes Control and Complications Trial (DCCT) [9]. In this review we will summarize the evidence of the benefits of near-normal blood glucose control on the development and progression of late diabetic complications, we will also focus on important areas of future research and how they apply in the clinical environment.
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