In search of better control for diabetes

Diabetes mellitus is by far the most ubiquitous microvasculopathy. The pathogenesis is reflected by reduced capillary perfusion, tissue ischemia (according to the pattern of capillary damage) and the consequential structural and functional damage. The current treatment is based on blood sugar control within accepted 'normal' levels. Adjustments to the treatment are made by clinical assessment of the accumulated damage to the patient's various organs, related to his last check-up. This strategy of 'damage-assessment' has been the cornerstone of medical practice in this field since the discovery of insulin. Modern imaging technology enabled real-time quantitative assessment of the blood cell flow in individual retinal capillaries in animals. Using such technologies in diabetic patients, the capillary blood flow disturbances, prior to the development of irreversible damage, might be recognized and understood. Such knowledge will enable the design of more sensible 'damage-preventing' treatment strategies for these patients.