Can diabetes be free of complications if it is well controlled?

Judging from clinical follow-up and the actual situation of thousands of diabetic patients I have contacted, it is possible with a high probability, but no one can guarantee that it will not happen 100% of the time.

The 72-year-old Uncle Zhang I know has been diagnosed with type 2 diabetes for 38 years. His glycosylated hemoglobin is now stable between 5.8% and 6.2% year-round. His blood pressure, blood lipids, and blood uric acid are all within the normal range. He undergoes annual complications screening and his fundus, kidney function, and peripheral nerve conduction are all fine. Even the carotid artery plaque is lighter than that of an elderly person of the same age who does not have diabetes. In addition to taking half a tablet of metformin every day, he only eats 70% full when eating, and walks briskly for 40 minutes after meals. He takes his grandson to the park and travels every day, just like a normal person. He is a typical example of a person who relies on standardized management to avoid complications.

Of course, there are different opinions. In clinical practice, we can indeed encounter a very small number of people with diabetes. Even if their blood sugar has been controlled very well after diagnosis, they may develop mild fundus microaneurysms or mildly elevated urinary microalbumin. The academic community is still not fully aware of the reason behind it. Some scholars believe that high blood sugar before diagnosis has been silently damaging the endothelium of blood vessels, just like wood that has been soaked in water. Even if it is never touched by water again, it cannot return to its original dense state. ； There is also a view that it is related to individual genetic differences. Some people are born with lower tolerance to glucose toxicity. Even if the blood sugar fluctuation range is within the standard range, it is already an unbearable stimulation to his capillaries.

But don’t use this low-probability event as an excuse to indulge. Among the cases I have come across, the proportion of "complications still occur under sugar control" is less than 3%. The remaining 97% of people with early- and middle-stage diabetes can basically delay the occurrence of complications by twenty or thirty years as long as they can keep the core indicators of blood sugar, blood pressure, blood lipids, and weight within the target range, quit smoking, limit alcohol, and stay up late. Many people will never have serious complications that affect their quality of life until the end of their lives.

To put it bluntly, diabetes is like sediment mixed in your tap water pipe. If you install a high-quality filter early (scientific sugar control), check and replace the filter element regularly (screen for complications every year, and adjust the control plan in a timely manner), the water pipe can last for 20 to 30 years without being blocked or leaking.； If you wait until the sediment has corroded the pipe wall into pits or even blocked it before you think of repairing it, then no matter how good the filter is, it will not be able to save the broken pipe.

What I usually tell people with diabetes the most is, don’t always worry about “whether there will be 100% no complications.” If you put all the necessary control measures in place and take 97% of the initiative in your own hands, it will be much more effective than being anxious every day. If you are really unlucky and encounter those 3% of special circumstances, early detection and early intervention can minimize the impact and not delay your normal life at all.