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 