Diabetes mellitus. A perspective on management

Diabetes mellitus results in multiple complications including over 10,000 new cases of blindness each year in the United States. The evidence that consistent good control significantly reduces these complications is overwhelming, i.e., a return to normal or close to normal glycemic state. This evidence is reviewed. Particularly noteworthy are data showing that when hemoglobin A1c values are consistently less than 8.4% (with 8.0% being the upper limit of normal), only 2.9% of subjects with existing retinopathy progress to a more severe retinopathy, whereas with higher hemoglobin A1cs, there is a progressive increase of severe retinopathy. Multiple biochemical hemodynamic and endocrine processes which appear abnormal in diabetes, return to normal when euglycemia is reestablished. Despite such evidence, physicians often resist conclusions regarding proper management of the diabetic state. The reasons are briefly reviewed.