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Duane, sorry for your troubles, really.all, just want to post a few facts. the DCCT trial conclusively demonstrating that "tight control" dramatically decreases secondary problems of type 1 diabetes was completed in 1993, just 16 years ago. that notion of "tight control" was to get people to or below A1c =7, a value we all know is still to high, but showing that people before then were "allowed" to be pretty out of control but still considered "OK". i have posted a link to that study on this board some time ago. it contains impressive graphical data leading to the conclusion above, tigher control = better outcomes. so anyway, there was not clear evidence before 1993 that glycemic control had good outcomes. it was AFTER the DCCT, 1994 that a committee was set up to come to agreement on standardizing the A1c test, in the form of the National Glycohemoglobin Standardization Program. i have the five year report (on progress up to 2000) on a pdf, but it can also be found here in the Journal Clinical Chemistry: http://www.clinchem.org/cgi/content/abstract/47/11/1985so it is not till ~2000 that things had gotten pretty well standardized. we know doubt will learn more about control with the passage of time, which of course no one with the disease can really afford, but that is just what life hits you with. the one remaining really big unknown in type 1 diabetes is the long term effect of the absence of C-peptide, a fragment cleaved off of the peptide that is to become insulin. as well as insulin, type 1's lack c-peptide. there is growing evidence that c-peptide may impact and improve renal and peripheral vasculature and perfusion. the sad part is that there is no patent on c-peptide and so almost no financial incentive to develop it pharmacologically. however there are companies formulating delivery methods, if enough data amasses proving its utility. by the way, many physicians are unaware of these things about c-peptide and only know of it because the test to detect c-peptide is used for a definitive diagnosis of type 1. that is the thing to keep in mind about physicians, they are practitioners, rarely up on the latest advances except in so far as they have been brought in on the lunch cart wheeled in by the pharma sales person.
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