Limitations
The authors of the DCCT noted that they were unable to show any reduction in cardiovascular morbidity and mortality. This is important because people with diabetes are two to four times more likely to have heart disease than persons without diabetes, and 75% of all diabetes-related deaths are from cardiovascular disease. A possible explanation for this is that the population studied in the DCCT was relatively young (the age range of participants was 13–39 years), and therefore their likelihood of having a significant cardiovascular event during the follow-up period was low. Furthermore, although they observed a far greater increase in hypoglycemia than there was reduction in eye, kidney, and nerve damage, they failed to note this in the conclusions.
To succeed with intensive therapy, a person with diabetes must take three or more daily injections of insulin (or insulin pump therapy), four or more daily blood glucose tests, and follow dietary and insulin dosing instructions. The principle underlying the belief that more diabetes education will improve a person's ability and/or desire to practice intensive insulin therapy is grounded in the assumption that it is reasonable to expect a person to perform these acts every day for the rest of his or her life.
When all is said and done, the fact remains that the rate and incidence of blindness, amputation, heart attacks, and kidney failure caused by diabetes—as reported by the NIH—continue to rise, suggesting that there are limits to the expectation that current treatment modalities are capable of delivering on the full promise. Insurance companies and health care providers ponder this failure and, with few exceptions, conclude that "educating diabetics" to adhere to an intensive regimen of injections and diets will somehow miraculously solve the problem. But some make a fairly compelling argument that the treatment itself is unreasonable and, that until issues related to hypoglycemia and human behavior are resolved, intensive therapy will remain a lofty theory that fails abysmally in practice.
Read more about this topic: Diabetes Control And Complications Trial
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