Prevention of the complications of diabetes

Until drugs that will prevent metabolic derangements that cause the complications of diabetes have been developed, the best approach to their prevention is control: of hyperglycemia, of hypertension, of obesity, and of smoking. Intensive insulin therapy, although demonstrably effective, must be approached with caution because hypoglycemia is a potentially life-endangering threat. Conversely, a Danish study has demonstrated a decrease in hypoglycemic episodes with intensive insulin therapy (Parving HH. Personal communication, 1988). With this in mind, it may be essential to bring blood glucose levels into a reasonable range shortly after the diagnosis of diabetes mellitus has been made. Insulin therapy is required for type I diabetic patients, and it may also be an appropriate therapy for all type II patients who do not become rapidly normoglycemic following diet and oral sulfonylurea treatment. Some physicians believe that a frontal "attack" of a split-mixed program of insulin therapy when type II diabetes is diagnosed is of psychologic as well as physiologic benefit, impressing the patient with the importance of control and vigilance. Compliance to rigid dietary change is notoriously unsuccessful, and the "trial-and-failure" approach, often ending in insulin therapy in any case, may not be the most effective. The advent of easy-to-use blood glucose monitoring devices and convenient and discreet insulin delivery systems has made maintenance of glycemic control less difficult for the insulin-using patient. New antihypertensive agents, lipid-reducing drugs, and second-generation sulfonylureas that do not affect the quality of life are now available and should be used in the person with diabetes as necessary.(ABSTRACT TRUNCATED AT 250 WORDS)