what they don't say (enough)

Distortions and omissions in the diabetes discourse are a recurring theme here - usually how:

• Medical research is dominated and distorted by deep-pocketed industrial interests.
• Standards for self care and even for diagnosis are shockingly - it is no exaggeration to say fatally - inadequate.

My top-of-mind short list for the biggest diabetes information gaps* includes: 

• Diabetes is complicated. Volumes of research produce inconclusive and contradictory results.
• Diabetes-related research may be badly reported, or just plain bad.
• Evaluating research, assessing risks and benefits, and devising a working strategy for self care are not helped by the cognitive deficits, depression, and fatigue associated with blood sugar highs and lows.
• Drugs used to treat diabetes and/or its comorbidities may increase the risk of death or morbidity, including onset of diabetes itself and incidence of comorbidities. 
• Blacks, Hispanics, American Indians, and Pacific Islanders are known to be at higher risk for developing diabetes. Less discussed are the risks conferred by a range of circumstances: socioeconomic status, stress, sleep, inadequate health literacy and education, location, and exposure to plastics and to environmental pollution. These factors often trump genetics; they can increase diabetes incidence and/or worsen outcomes.
• Lack of professional consensus, balky insurance plans, and physicians' disregard of patient-reported data may all interfere with getting adequate testing supplies to carry out tight glucose control.

In short, diabetes usually cannot be resolved by, as one pharmaceutical company shamelessly touts, "simple changes."

Of course, those of us with type 2 diabetes have it "easy." Those with type 1 can match all of the above point for point (with some variation) besides being burdened with:

• fewer treatment options 
• a more painstaking, invasive, and wearying—and typically decades longer—self-care routine
• immediate and potentially mortal risks that can come from monitoring and treatment errors

Cheery thoughts for a sunny winter's day! Well, they asked.*

Good heath and good luck,

M.

* This theme was suggested by an online survey for people affected by diabetes to gather "missing" information—"gaps" in what we hear and read—to incorporate into educational videos. WEGO Health, a platform for online health activists, made donations to diabetes organizations as part of their survey promotion. I didn't know much about the sponsors at the time, but thought they were asking the right questions. Edited from the original post: 2012-02-03.

remission defined

As reported in Endocrine Today online:

The [expert study group*] agreed upon the following definitions for patients with type 1 and type 2 diabetes:

• Partial remission: hyperglycemia below diagnostic thresholds for diabetes; at least one year’s duration; no active pharmacologic therapy or ongoing procedures.
• Complete remission: normal glycemic measures; at least one year’s duration; no active pharmacologic therapy or ongoing procedures.
• Prolonged remission: complete remission of at least five years duration.

The term remission may be more accurate than the term cure because “current or potential future therapies for type 1 or type 2 diabetes will likely always leave patients at risk for relapse, given underlying pathophysiologic abnormalities and/or genetic predisposition,” the group wrote. “It may make sense to consider prolonged remission of diabetes essentially equivalent to cure.”
The group modeled its consensus definitions on existing terminology for certain malignancies such as cancer.

*The group comprised experts from pediatric and adult endocrinology, diabetes education, transplantation, metabolism, bariatric/metabolic surgery, and (for another perspective) hematology-oncology.
source: Buse JB et al. Diabetes Care. 2009;32:2133-2135.