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What is Metabolic Memory?

Last year in San Diego at the American Diabetes Association meeting, new findings were presented about heart health in people with type 1 diabetes. A clinical study called EDIC (Epidemiology of Diabetes Interventions and Complications) showed that tight blood glucose control is key to preventing heart disease.

The study showed that maintaining tight blood glucose control could reduce the risk of cardiovascular disease in people with type 1 diabetes by up to 57%. According to this study, every 1% reduction in A1c leads to roughly a 20% reduction in cardiovascular risk.

EDIC is the follow-up to the Diabetes Control and Complications Trial (DCCT), a landmark study of 1,441 people with type 1 diabetes. The DCCT found that when people kept near-normal blood glucose levels with frequent testing and injections, they had fewer diabetes complications than people who injected insulin only once or twice a day. After the DCCT ended, 94% of the DCCT participants enrolled in the EDIC study.

The EDIC study showed that patients whose A1c levels were about 7% for six-and-a-half years had a 57% reduction in fatal and nonfatal heart attacks and strokes compared to patients whose A1c had been near 9% in the same time frame. The 7% A1c group kept their lower cardiovascular risk even if their A1c level rose in later years.

The idea that a few years of tight blood glucose control can have long-term benefits is called “metabolic memory.” Scientists do not know how long the benefits of metabolic memory can last. However, the fact that metabolic memory exists means that people with type 1 diabetes can really benefit by keeping their blood glucose in target as long as possible.

The new EDIC data, however, shows very strong evidence that tight blood glucose control has the same benefits for large blood vessels as it does for small blood vessels.

While the EDIC findings were based on people with type 1 diabetes, they may also apply to people with type 2 diabetes. That's because type 2 diabetes increases a person's cardiovascular risk by two to four times compared to someone who does not have diabetes.

If your blood glucose has not been on target, or if it has crept up recently, now is the time to act. With advances in blood glucose monitoring such as fine-gauge lancets and alternative site testing, and the tiny size of insulin syringe and pen needles, intensive management does not have to hurt. Today’s small, quick blood glucose meters that require tiny blood sample make glucose monitoring very discreet. Advances in blood glucose meter and insulin pump software have taken a lot of the guesswork out of intensive insulin therapy.

It is never too late to start controlling your diabetes. While the DCCT and EDIC studies focused on the long-term effects of tight blood sugar control, intensive diabetes management can help you feel better on a daily basis with more energy and mood to live your life.
Ramiro Antuña de Alaiz
Educational Treatment Unit
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