[Can late sequelae of diabetes be avoided? Various critical observations]

Hyperglycemia plays a decisive role in development of diabetic retinopathy, nephropathy and neuropathy. Unfortunately, even modern antidiabetic means often fail to install normoglycemia or near normoglycemia. They also bear an important risk for hypoglycemia. What glucose levels (as measured by Hb-A1c) may be tolerated without consequences for the patient is unknown so far; therefore, we should presently still aim at lowering the blood glucose as often and as close to normal as possible and try to avoid severe hypoglycemias. Those who care for diabetics carry a high responsibility. The care diabetics should be improved as follows: Regular ophthalmologic controls could reduce occurrence of visual losses or blindness. Efficient lowering of hypertension prevents occurrence and progression of nephropathy. ACE-inhibitors turned out to be also useful in normotonic diabetics, because they prevent progression of nephropathy. Diabetics bearing a risk for lesions on the feet should be identified, instructed and treated adequately. This is the only way to reduce the rate of amputations. Risk factors for general arteriosclerosis should be efficiently treated or avoided, particularly in diabetics. In consideration of these factors, morbidity and mortality of diabetic patients could be influenced more efficiently. There is no justification for any defeatist attitude.