I am confused as to the DCCT study and the onset of complications. After reading a lot on the Internet, I am getting the impression that doing a good job of controlling blood sugar, blood pressure and blood lipid levels, can still lead to complications. I am particularly worried about renal disease. I have read that after 15 to 20 years of diabetes and no renal disease, the odds are that one is “over the hump” and won’t develop kidney disease. In the real world (not the DCCT study), can you tell me the percentage of patients who do a good job in keeping the A1C 6.5% or less and still develop renal failure? There is no renal disease in our family, but my son’s paternal grandfather had high blood pressure and a heart attack at 48, which he survived. My son is the type 1 diabetic. His paternal family also suffers from high cholesterol levels. It seems the genes are lousy, so anything we can do to be in control would be helpful.

The answer to your question is much more philosophical than medical. However, one carries into this world certain genetic factors and then things that influence us including the environment, what illnesses we have and how we deal with such problems. Genes, of course, cannot be modified at present. Knowing what genetic disorders are higher or lower to show up in us or our kids, gives us some sense of risks and prognosis. Controlling blood glucose as demonstrated in the DCCT and many other such studies around the world is critically important. How one goes about doing this is very individualized. Setting up a monitoring system for all these problems is also important, i.e., going to the eye doctor annually, checking microalbuminuria and blood pressure at least annually after puberty, checking lipids, thyroid functions, celiac disease, etc. Knowing what is going on often allows one to take a medication earlier, modify a diet or exercise regimen, change an insulin program, etc. Thus, improvement occurs and earlier improvement works better than later changes.

SB