Bad Medicine: There Is a Lot Wrong with Diabetes Care in the United States

For decades the debate raged with regard to the relationship between glycemic control and diabetic complications. Ultimately, the debate ended with convincing evidence that tight glycemic control impacts the microvascular complications of both type 1 and type 2 diabetes mellitus. However, the issue of glycemic control in macrovascular complications remains somewhat controversial (The Action to Control Cardiovascular Risk in Diabetes Study Group 2008). Millions of taxpayer dollars were expended on clinical trials to prove conclusively the relationship between glycemic control and complications. However, translational efforts to bring this into routine clinical practice have, for the most part, failed. The current management strategy for diabetes (types 1 and 2) remains more of a bail-out system, with the clinical focus and fiscal expenditures being directed at the management of established diabetic complications, such as end-stage renal disease, advanced cardiovascular disease and advanced eye disease: and this, instead of preventive care. Suboptimal diabetes care is a phenomenon not only in the United States, but