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Monday, December 9, 2013
Can Well Managed Diabetes Avoid Complications?
Can you avoid the many complications of diabetes if your blood sugar is well-managed over the years, or are they inevitable regardless of glucose control?
The answer to this question is more complex than you may expect for such a simple sounding question. We have excellent evidence from clinical trials that the more improvement there is in blood sugar control, the lower the likelihood of experiencing the chronic microvascular complications of diabetes - kidney damage, eye disease, nerve damage in a variety of forms. We have just the beginnings of similar evidence for chronic large vessel complications of diabetes, such as heart attacks. Studies are in progress to determine more definitively whether heart attacks, strokes and death resulting from those events are reduced by tight blood sugar control. The key concept though is that they reduce the likelihood - we are not at the point of saying that tight blood sugar control prevents these completely. There are several reasons we can give for this. First, exquisitely normal blood sugar control is very difficult to achieve in some people - it is quite an achievement to make major improvements in some even if we cannot achieve perfectly normal. Second, there are other factors besides blood glucose control which contribute to some of these complications - we don't know what those are in all cases. Third, complications develop over long periods of time. Not only do we have achieve great blood sugar control but we have to maintain it for long periods of time to completely prevent some of these problems.
The major message is that there is a health benefit to any substantial improvement in blood sugar control and there is likely to be a greater benefit the better the control is.
Robert M Cohen, MD
Professor of Clinical Medicine
College of Medicine
University of Cincinnati