This is a good news + good news + bad news scenario, Folks. From announcements made at the ADA Conference in Philly, we’ve learned that long-term insulin use is shown to be safe – even Lantus use does not cause cancer risk! – but on the whole, type 1 diabetics in America aren’t faring so well, health-wise.
A huge and unprecedented study by the name of ORIGIN (Outcome Reduction with 
Initial Glargine Intervention) is the first-ever to investigate the risks of taking insulin on a long-term basis. Happily, researchers found that the risks are low! Daily injections “neither increased or reduced the risk of heart attacks, strokes, cancer or cardiovascular-related mortality.”
Albeit, this study was conducted on more than 12,500 patients either at risk for, or in the early stages of type 2 diabetes, but there’s no reason to believe the results are not applicable to type 1s – the most likely folks to be taking insulin over loooong periods of time.
“ORIGIN’s findings should reassure patients and clinicians regarding the long-term health impact of using basal insulin therapy to target normoglycemia,” said principal investigator Hertzel Gerstein of the McMaster University Department of Medicine in Ontario in a press statement.
(Normoglycemia?! Is that an official medical term? Who cares? I love it!)
Related European/U.S. studies counteract earlier claims that use of the long-acting insulin Lantus is related to cancer risk. Kaiser Permanente examined data from 115,000 patients using either Lantus or NPH, and found “no evidence of an increased risk for cancer … and specifically no increased risk for breast cancer in the small group that stayed on these drugs for more than 24 months,” according to principal investigator Til Sturmer of the Center for Excellence in Pharmacology and Public Health at the University of North Carolina.
This is all good news of course, but…
New National Type 1 Diabetes Registry Reveals…
As mentioned earlier this week, the Helmsley Charitable Trust’s new T1D Exchange program (which we previewed here) represents the most comprehensive analysis of people with type 1 diabetes ever undertaken in the United States.
The T1D Exchange Clinic Registry now contains self-reported data from more than 25,000 patients of all ages from 67 clinics nationwide.
The organization is just now beginning to synthesize all this data to find out what kind of picture it paints of life with type 1 diabetes in the U.S.
So far, it’s not a pretty picture at all. They report:
- Most people with type 1 in the U.S. fail to meet ADA treatment targets of an A1C of 7 or below
- Adults with T1 average A1C of 7.5-8%
- A majority of adults with T1 are overweight or obese (matching the stats of non-diabetic America!)
- Average A1C for under age 12 is 8.3%
- For ages 13-17, average A1C is 8.7% (those rocky teenage years!)
- Oddly, older adults (age 50 and up) had the best average A1C of all the groups, at 7.6% — but they also had a surprising percentage (14-20% per year) of hypoglycemia, including events like seizure, coma, and ER visits
- In T1s over age 40, 20-30% are already living with diabetes-related complications
Ouch.
Another new study shows that type 1 diabetes is significantly on the rise in this country; diagnoses are up 23% between 2001 and 2009!
As a type 1 in my, ahem… 40’s, this data does not make me happy. I have to remind myself that most of the people in the T1D Exchange analysis so far are probably not LADAs, like me. Meaning they’ve had diabetes much longer, and lived through those “dark ages” when we didn’t have the array of effective tools and medicines we have now.
But still… I’m so with Dr. Richard Bergenstal, executive director of the International Diabetes Center and vice-chair of the T1D Exchange, when he says:
“Obviously we need to do a better job of helping all people with type 1 reach target treatment goals, address disparities in care among racial groups, and investigate why older patients with type 1 are experiencing such a high rate of dangerously low blood glucose levels … as they strive to improve their overall glucose control.”
There’s no doubt that knowledge is power, and finally having solid data on people with type 1 across the nation is a hugely powerful thing! I for one can’t wait to see what comes next from the T1D Exchange program and its new related online community for PWDs called MyGlu.org, which we previewed in a comprehensive post last fall and has just recently opened for everyone!
(Disclosure: I was part of the San Francisco promotional photo shoot for MyGlu and my pic appears in their current email updates – very happy to pitch in for this excellent cause!)
When I lived like most people around me, I couldn’t meet the ADA below 7% recommendation. When I began to eat and live differently from most, lower my carbs, cut out processed food, I quickly lowered it and have maintained it under 7% for years now. (There is more to it than that) But I really think our entire way of life needs to be modified. It clearly isn’t working.
I’m with you, knowledge is power. I’m sure awareness on this will only help
Amen Sys,
As long as the ADA continues to recommend a carbohydrate based diet things won’t change and will get worse. My a1C was 5.9 in April by eating a low carb (less than 50grams per day), no artificial sweeteners, high fat, protein and veggie – eating fabulous foods including Almond Meal based baked goods. On the pump and CGM, my daily average insulin is 15units, mostly basal. 40 years old – Type 1.
Hi Robert, I’m 32 and been type 1 diabetic since i was 12. I’m on the pump and well controlled (AIc is usually 6.2) but I want to get a better grasp on things and i’m sick of eating the same old stuff! Being T1D yourself and on Paleo, is there a meal plan you can recommend for me just so i can see the types of foods that are working for you? thank you in advance, Kim
I’m also surprised by the T1 A1C stats. I wonder how the numbers break down for those on a pump vs injections
“Most people with type 1 in the U.S. fail to meet ADA treatment targets of an A1C of 7 or below”
- because they are continuously advised to eat carbs. so counter-intuitive.
sorry, I see everyone beat me to it.
it all so well. People don’t understand what I mean when I say that Diabetes is my nubmer one priority but those people often don’t understand that EVERY decision you make, you HAVE to think about how it will effect your diabetes. So thanks again…it’s nice to not feel so alone with this disease
Robert, my daily insulin has dropped from ~120 to ~65 since switching to the Bernstein plan. no BGs over 200 in 2 weeks. I can think clearly, I can exercise without pain, sleep is better. etc, etc.
MikeC – Awesome Job! Bernstein was an early proponent of this – I got his book years ago and the latest activity around the Paleo diet has created a wealth of info for diabetics.
Hi Robert I would like to find out how can I get hold of Dr Berstein’s book as I live in South Africa and if I want to order the book it will be a waiting period of around 3 months if there is more people wanting it or it can take even longer. I am T1D struggling to get my A1c below the recommended standards of below 7% but really would love to reach my target. As I am a fire fighter to and doc says in my work I need to be below 7% and I am at 8.2 now?? Please help???
I get tired of hearing/reading about “treatment” for type 1 diabetes. How about no more “treatment” and just “cure”? Dr. Denise Faustman has found the cure, but I fear that the ADA and the pharmaceutical companies will never allow PWDs to ever have it.
It is possible to have respectable a1Cs and still eat a reasonable amount of GOOD carbs. I eat 270-300g of carbs a day and my last three a1Cs were 6.2, 6.0 & 6.4%. It’s not rocket science, but the most important thing I’ve realized lately is that my control DEPENDS upon me exercising very regularly and vigorously. I need that exercise to lower my insulin resistance. Until I developed LADA, I could get away without exercise and just cut back on the feed to control my weight. My diagnosis was an (im)perfect storm, as I developed it just on the cusp of middle age, so I really needed to start exercising regularly anyway.
It really surprises me that the majority of Type 1s are overweight or even obese. That’s not what I see in my life at all. I would be interested in seeing that data and how they define both Type 1 and overweight.
It’s not been my experience, either, but that may be due to the fact that there are so few T1s, and the ones we tend to see (going to conventions and to fundraisers) are those that are more serious about getting their D under control. I didn’t find out I was LADA until about a year ago (they thought I was Type 2, despite my tall, skinny somatype) when my pancreas stopped producing enough insulin to cover meals.
Following my nutritionist’s guidelines and using Novolog, my 8.2% became 6.0% in three months. When my control is that tight, I too have problems with hypos.
At the Adult Type 1 meetings I attend there are people of all body types, some very athletic, others more voluptuous. A lot of the shock around the statistic is that Type 1s are shown by the media as either tiny children or super-athletes, whereas Type 2 is chained to obesity. The truth is more diverse.
My A1C while adhering to ADA recommendations was 8.5. I happened to find an online Diabetes forum that encourages restricted carb intake. New A1C is 6.1. I feel better although I still have too many hypos in spite of lowering my basal rates a number of times.
Sorry but the whole – No carb thing for A1C is not the only solution. I just had an A1C of 6.8, previously I had 7.4 and 7.2. These are decent, my doctor wants them lower but I have to admit- I eat LOTS of carbs. The problem is there are different types of carbs and carb counting is hard- You have to work at it and it is mostly trial and error.
Now the next point I would argue is that an A1C below 7 is also not necessarily in the patients best interest. As the article states elderly have higher rates of Hypo epidemics which is FAR more dangerous than being “slightly” elevated A1C. There was a study (last year?) that also supports this fact. Eldery patients with A1C in the 7s had no difference in diabetes related “complications” than their counter parts in lower A1C ranges. What they found though is that the lower A1C ranges had higher mortality rates. DEATH. that’s not what we want. Sorry.
It’s about what works for YOU. There’s something in MY genetic makeup that makes it OK for me to eat the way everyone else is supposed to eat, whether it’s the food pyramid or the plate approach. My plan is to try to shoot for 6.8-7.0%, which will cut down on my lows. The most difficult thing that I have to do is get the right amount of food/insulin for when I exercise.
I, too, have never been able to figure out how to add regular exercise into my routine without my BG’s going either too low or too high.