Diabetes is the scourge of mankind .( Womankind too ! In fact it affect women more than men !) When we say DM & Cardiovascular disease we mean the type 2 maturity onset DM .Even a lay person can recognise the strong link between DM and increased cardiovascular mortality .
While logic would make the same lay person believe , that proper control of diabetes will eliminate CVD risk that was acquired . Alas . . . how foolish science can be
The problem in medicine is 1 + 2 is 3 only if it’s counted antegradely , 2 + 1 is rarely three !
Unfortunately even many of the medical professionals do not realise this fact and keep the logic above reality and continue to believe in what they believe .
When we find, a disease process that tend to continue even after the offender ( Here incresed blood sugar ) is removed then there is questionable relationship between the offender and the victim .
This is what we have learnt in over 50 years of diabetic research . Now we have so much controversy and confusion.The savior of diabetes insulin itself may be the offender (ACCORD Trial ) Or is it insulin like growth factor , or circulating peptides ( named and unnamed )
So the debate and research goes in an unknown and uncharted direction . . . The drug companies periodically need some studies to bond the link between DM and CVD to keep the per capita consumption of antidiabetic drugs .
And the only fact remains true is a good life style with physical activity with peaceful pursuit of life will keep the diabetes at bay . . .
So till that time we reach the reality , there is no other option but to experience articles which add on to the confusion rather than clarity .Read the latest metanalysis about the link between DM & CVD . . . and I can assure you the confusion is guaranteed
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60697-8/abstract#
Expect soon another trial , that contradicts the above trials conclusion .
Title talk
So now you can answer the title question : Why we struggle to prove the beneficial effect of strict diabetic control on cardiovascular events ?
We struggle because , the beneficial effect is so little or even may be non existent !
Dr.S.Venkatesan MD 
Highly biased views. Its the actual time frame,and not patients years, which gives a clearer view about real long term macro vasculer benifits and also dependson the way the diabetes was treated from the very begining in particular individuals
Hi
Thank you for your observation.I agree it is a extreme way of looking at diabetes and cardiovascular disease.But
the purpose here is to stimulate our thinking and reiterate our ignorance on the issue.
May be right , we have to look for some other targets for diabetic management other than blood sugar.
We have learnt over the years women get for more serious complications of diabetes than men.This needs some introspection
I am Sorry , for using harsh words in my article but when we realise unbaised views are not doing it’s job. biased views some times can . . .
S.Venkatesan