There is a long-standing controversy between diabetologists as to whether the level of metabolic control of diabetes mellitus affects the long-term outcome. The traditional belief has been that the cardiovascular complications are a result of the metabolic derangements. Until recently, this position, however attractive, lacked substantial basic and/or clinical verification.1.2 Within the past two years,3 several studies have appeared that significantly increase the scientific basis for this position, while remaining inconclusive in a practical, therapeutic sense from the point of view of this author.
The cardiovascular complications of diabetes mellitus are of two distinctly different types. The lesion most characteristic of diabetes is the microvascular lesion, resulting in blindness, progressive renal failure, and neuropathy. It is this process that is responsible for most of the morbidity and mortality in the insulin-deficient patient of childhood or young adult onset. Several investigators have proposed that chronic hyperglycemia or some related