June 1, 1999
Question from Copenhagen, Denmark:
A research programme has just been launched within the Nordic countries. The programme amounts to around 13 million dollars and the focus is on diabetic complications. Novo provides the programme. Newspaper articles connected with this news say that 50 percent of all diabetics will experience complications later in life. That’s not a very good prospect for my girl aged 7 and diagnosed one year ago. We maintain her at a HbA1C in the range 6.6 – 6.9 and are quite happy with it.
My questions are:
Is the 50 percent probability correct in general?
Is it correct for our girl, with the HbA1C quoted?
Diabetes is associated with a very high morbidity otherwise there would not be such a huge effort put into managing it better. However it all depends upon what you call complications. You will be aware that the DCCT proved conclusively that good blood sugar control reduces the rate of problems with small blood vessels by 60-70%: i.e. eye, kidney and nerve damage. People with diabetes are also at higher risk than average of stroke and heart attack but again, we believe that care with diet and prompt treatment of high blood pressure ameliorates these risks.
I often tell parents of new patients that the figures in textbooks are necessarily out of date. After all, we have only had home blood sugar testing and HbA1c analysis for a relatively short time and there is plenty of evidence that these have reduced morbidity.
You are doing a great job with your daughter and if you (and she) continues to have such good control, she eats a healthy diet, takes exercise and doesn’t smoke, she has an excellent chance of a long healthy life.