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February 26, 2002

Tight Control

Question from a physician in Montreal, Canada:

I'm currently completing a residency in ophthalmology, and I have met a lot of people who have diabetes during my years of training. One very important person for me is someone who has had type 1 diabetes for 12 years. She was able to control her blood sugars extremely well, keeping a mean hemoglobin A1c well under 7.0%, while having a good diet and doing lot of exercise. She, of course, has no complications, and in my practice, I have seen many people who have had diabetes for more than 40 years without any complications. I think that, if you can maintain a mean blood sugar level near normal (A1c under 7.2%, as shown in the DCCT trial) over your entire life with diabetes since the time the diagnosis was made, you will not experience any complications and you will live a normal long life. This is not just hope; it's medically proven information. Of course, to achieve that, you will have to treat your high blood pressure, your high cholesterol level if you need to and you will have to stop smoking as soon as possible if you do smoke. I would like to know if you share that kind of view on the subject.

Answer:

I think that everyone who helps to care for people with diabetes would agree with your point of view — especially after the results of the DCCT became available.

The problem, which to some extent you escape as an ophthalmologist, is to find the time, skills, resources and continuing support for everyone who needs these.

DOB