Cardios, Nephros, PCPs -- We're All Diabetologists Now

A surgeon once said to me, "I wish I had your job. All you do is adjust medications here and there to control blood sugars."

"I'm a diabetologist, not a glucologist," I said, to which she replied, "To-may-to, to-mah-to."

Until about a decade ago, most major diabetes studies looked at outcomes associated with intensive versus conventional glycemic control. Some trials showed that better control of blood sugar levels led to a lower risk of developing microvascular complications, but many cynics countered that the effort-to-benefit ratio didn't seem worth the trouble, as reduction of hard outcomes, such as death and cardiovascular (CV) events, remained elusive.

Sure, diabetes was christened a CV risk factor, but no study had conclusively shown at that time that controlling diabetes actually made a difference in CV outcomes. Even though landmark trials such as Steno-2 showed impressive outcomes in dyslipidemia, blood pressure, and microalbuminuria with intensive control of blood sugars, the treatment of diabetes continued to be relegated to achieving a certain A1c target.

Studying CV Outcomes

This began to change gradually in 2008, when the US Food and Drug Administration mandatedthat all new diabetes medications undergo dedicated CV outcomes trials to establish that they don't increase the risk for CV mortality, nonfatal