One reason we need a real “cure” for diabetes is that most “free range” diabetic patients can’t manage their diabetes consistently well enough for several legitimate reasons that modern medicine can’t really change.

The landmark Diabetes Control and Complications Trial (DCCT) proved the virtues of tight blood sugar control. Yet it took a decade to conduct (1983-93) and required near superhuman effort to keep 1,440 people with type 1 diabetes in consistent diabetes control over that entire time.

But the real story behind the DCCT is what still haunts us today. It’s our inability to apply its conclusions and recommendations into the lives of millions of people struggling with diabetes across the globe.

Several things had to happen in order for DCCT to happen, which are the real reasons we have never been able to duplicate its results on a large scale in most type 1 diabetics. It’s been said that only 5% of diabetic patients can even now possibly attain and sustain DCCT-like levels of blood sugar control.

Patients enrolled in the DCCT were between 13 and 39 years of age at the start of the study. That meant that applying the results to patients outside those ages would not be scientifically defensible or maybe even wrong. Yet, I see that being done now by pretty much everyone in the profession.

Next, (and this is DCCT’s real dirty little secret) all study patients were prescreened for any pre-existing mental health or social conditions that would keep them from being able to maintain good control of their diabetes. In other words, potentially non-adherent patients were systematically excluded from the study. If I had the ability to pick and choose “winners” like that in the real world, my clinical outcomes would look fantastic too. But the world is full of poorly motivated, mentally/socially challenged and frankly mentally ill adults and children who just happen to have diabetes too. Where do they fit in this model of diabetes health care delivery? They don’t.

Everyone in the DCCT was provided diabetes supplies at no direct cost to them. This included insulin, syringes, insulin pump supplies, meters and test strips, etc… everything but food. When we consider the high costs of daily diabetes care now, this becomes a significant financial barrier to good outcomes. In the current discussion about health care reform resulting from tens of millions of uninsured Americans , diabetes ranks high on the list of financially crippling diseases that often get neglected simply because there is no way to pay for the proper care and equipment, or the diabetes self care education needed to manage it each day.

Finally, (and this also speaks to resource allocation) consider that DCCT patients in the treatment group (aimed at keeping A1c low and keeping it there) all got monthly visits to the diabetes doctor and weekly calls from the diabetes nurse to make constant adjustments in their daily management aimed at keeping blood sugar levels in tight control. Communication was almost always by phone or fax. In that regard, DCCT was the first study to really prove the value of telemedicine and diabetes care outcomes on such a grand scale. And this was accomplished well before cell phones, text messaging, computers and the Internet began to permeate our everyday lives.

Ultimately, the DCCT represents a search for a “Holy Grail”: perfecting blood sugar control and lowering the long term complications of diabetes. But like the legendary Holy Grail, this one still remains undiscovered and may never have really existed in the first place. In the end, the power to succeed over diabetes lies in every one of us. DCCT proved it could be drawn out in a select few. But as our natural riches may be buried at different depths within the ground below, how deep do you and others have to drill down in order to unleash your power within?

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This entry was posted on Sunday, August 16th, 2009 at 11:17 pm and is filed under Behavioral. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.