A major study by Joslin Diabetes Center researchers has found that some people who have survived diabetes for many decades exhibit remarkably few complications — a discovery that points toward the presence of protective factors that guard against the disease’s effects.
The scientists studied 351 participants in the Joslin 50-Year Medalist study, which examines people who have lived with type 1 diabetes for 50 years or longer. Among this population, 43% are free from advanced diabetic eye complications, 87% from kidney disease, 39% from nerve disease and 52% from cardiovascular disease.
“[The Medalists] are strong evidence that protective molecular, physiologic or genetic mechanisms, in these fortunate individuals, fight against the toxic effects of high blood sugars over many decades,” Jennifer Sun, MD, first author on the paper published in Diabetes Care, stated in a press release.
As a group, the Joslin Medalists are careful about controlling their blood glucose levels. However, within a reasonable range of glucose control, the study found that freedom from complications does not appear to correlate with how well these unique people controlled the blood sugar levels that go awry in diabetes. This conclusion differs from results shown in every other major recent study of diabetes management.
Clues to this protection may be found in analyses of a family of proteins called advanced glycation end products (AGEs), which are increased by high blood sugar levels. In the study, participants who exhibited two specific AGEs were more than seven times as likely to have any complication. But this study also demonstrated for the first time that a combination of two other AGEs is associated with protection against eye disease.
Additionally, the researchers found a group of Medalists, followed at Joslin’s Beetham Eye Institute, whose diabetic eye complications stabilized after 17 years at a mild stage rather than continuing to worsen as expected. This finding again indicated that protective factors are present in this group.