By: Alan Marcus
Dr. Alan Marcus is a diabetes specialist who practices in Laguna Hills, California. He is a medical advisor to MiniMed Technologies, a spokesperson for Novo Nordisk, and an Assistant Clinical Professor of Medicine at the USC School of Medicine.
In response to Joan Hoover’s article “The DCCT Offers Nothing to Diabetic Patients,” DIABETES HEALTH Medical Advisory Board member Alan Marcus MD offers the following rebuttal.
The purpose of the DCCT was to scientifically, not anecdotally, determine if tight control actually affected complications. The answer, a resounding yes, is meant to encourage those people already working hard toward achieving normal blood sugars and to silence those physicians, scientists, and patients who require a large volume of numbers, statistics, and complication rates to believe what the rest of us already knew as a simple and basic truth. Unfortunately, people’s behaviors are not always influenced by truth and wisdom; other factors such as desire, ignorance, and motivation frequently intervene.
Why is the DCCT a failure, or is it really a failure? The DCCT gave us knowledge and facts, which is what it was designed to do. The rest of the story is how, or if, these facts are used. The New England Journal of Medicine says it takes 15 years for medical knowledge to become medical practice; they estimate 50,000 deaths per year due to this lag time. The DCCT concluded only one year ago. This is not an excuse, just an observation.
Is it the difficult skills or the high cost involved in trying to attain normal blood sugars that causes this delay? Let’s look at other facts regarding diabetes care. 1) Everybody with diabetes should have a 24-hour urine test for protein and kidney function at least once a year (to predict, prevent, and possibly reverse kidney and heart disease), which costs less than $100. 2) Every pregnancy should be checked for gestational diabetes by glucose load testing (to prevent short and long term complications to the baby and the mother). The approximate cost is only $65. Are these simple, inexpensive tests done by all patients and physicians? No! Studies conducted in Seattle and Los Angeles indicate these tests are done or understood by less than 20% of all physicians. Does this mean they are failures? Is it the fault of the physicians for not ordering it, the patients for not insisting on it, or the educators for not instructing about it?
Scientific advances consist of two parts, discovery and use. The DCCT has given us the discovery that better blood sugar control is better health, not that perfection is sublime and all else is failure. It is up to all of us, patients and physicians alike, to reinforce the importance of free will rather than confirm the false notion of a wholly impersonal fate. We have to enter into a relationship where we help each other do better rather than search for scapegoats.