[Degenerative complications of diabetes]

Even optimally treated insulin-dependent diabetes mellitus is responsible for a significant number of complications which impair daily activities and shorten life expectancy in most patients. The cause of these complications has been under investigation for many years. Substantial evidence supports the following 1) a role of high blood sugar levels which lead to glycosylation processes; 2) presence of disorders related to inadequate nutrition, and specifically excessive dietary intake of saturated fatty acids, rather than to insulin deficiency. Furthermore, hereditary factors may play an additional role (HLA haplotypes may promote the development of complications). Antibodies and/or hormonal factors may also be involved. Whatever the mechanisms involved, there is no doubt that every effort should be made to achieve normal blood sugar and lipid levels. But what is the optimal degree of control? What is the ideal diet? Is it necessary to risk severe hypoglycemia? Should insulin pumps be routinely used? Since many of these issues are as yet unresolved, there is a need for collecting valid data on long-term complications with several therapeutic regimens. Unfortunately, most of the many published statistical studies on these complications are virtually invalid. This fundamental issue is discussed. The authors urge diabetes mellitus specialists to use the actuarial method already used by oncologists for many years.