Diabetes

“For Joslin and other American practitioners throughout the twentieth century, the central ambition of diabetic management – and its chief frustration – has been the want of control. The eagerness with which physicians have pursued this elusive object, and in what directions, have distinguished various styles of managing the disease. Joslin may have declared partial victory at mid-century, but the advance of an alternative clinical style, which was less stringent regarding control and more concerned that patients live ‘normal’ lives, would put his beliefs on the defensive for several decades. Since the 1950s, physicians have debated whether control could prevent long-term complications, and if so, how effectively. In 1993, the published results of a large clinical trial argued that Joslin was essentially right; patients placed on tight-control regimens, compared with those under normal diabetic care, lowered their risk of delayed complications markedly. But this reduction of risk, important though it is, does not settle a more fundamental argument: even if the means of better diabetic control are now ‘at our door,’ the questions of what measures should we take to pursue control, and at what personal consequence to patients’ lives, remain open, beyond the dictates of statistical data” (Feudtner, 143).