From Diagnosis and Classification to Complications and Therapy: DCCT Part II?

Abstract

I have long been concerned about our approach to diagnosing diabetes. While one can readily agree that an elevated blood glucose level is a key component of diabetes, I strenuously argue that the cause of that blood glucose elevation is also of critical importance, i.e., a deficiency in insulin action. Diabetes is, after all, an endocrine disease, and it has always disturbed me as to how little diagnostic attention is paid to the concentration of the hormone involved. This is, I believe, unlike virtually all other endocrine diseases. Instead of measuring insulin (along with glucose), we have become obsessed with the oral glucose tolerance test (OGTT), which I view as a highly variable test of an unnatural gastronomic excess.