Controlling diabetes: the need for intensive therapy and barriers in clinical management.

Although diabetes is a manageable condition, its prevalence worldwide has increased dramatically in the previous four decades. The principal goal of diabetes management is to prevent the microvascular and macrovascular complications of the disorder, which are associated with elevated blood glucose levels. Many large-scale clinical trials have demonstrated the benefits of intensive therapy regimens in lowering hemoglobin A(1c) (HbA(1c)) levels. However, despite detailed guidelines issued by several major international diabetes organisations, we are largely failing to reach their recommended target HbA(1c) levels. Although there have been many recent therapeutic advances for treatment of diabetes, three issues have emerged that affect the success of intensive therapy--hypoglycemia, weight gain, and physician-reluctance. Regardless of specific therapeutic regimens, each of these barriers in clinical management must be addressed individually and collectively if we are to effect change in disease outcomes for persons with diabetes.