Firstly, I'm in England, so subject to the vagaries of The NHS[National Health Service] and NICE[ National Institute of Health and Clinical Excellence!]
We also have the advice of Diabetes UK[ our national diabetes charity]of which I'm a member.
I have a major beef with all of them. TARGETS!!!!
Blood glucose levels and Hba1c levels.
WHY are these so High?
To me it only makes sense that diabetics aim for NORMAL blood sugars[as Bernstein says, we have the right to normal blood sugars]
the targets set by the medical profession are much higher than that. some are double. A normal A1c is around [or below] 5%} so why a 7% target? and non diabetic blood glucose rarely deviates far or for long from around or just below 5mmol/l [90mg/dl]
Especially in the US where a 7% A1c in a new patient allows for a diagnosis of diabetes.
I accept that not everyone can hit the normal levels, but if you were at an archery competition, You wouldn't move the targets to where nearly everyone could hit them.
You would accept the target and work to improve your aim.
That's where I think the Healthcare profession is letting the patients down.
the only reasons for these unhealthy tarets that I can find are to do with protecting the medical profession.
Thus if patients hit the targets as set, and still develop complications, it's bad luck or the normal pattern of the disease. It can't be blamed on their healthcare team.
I do loads of voluntary work and recently at a meeting, I challenged a representative of NICE on this point. He agreed with me. Maybe we'll get somewhere???
My main quarrel with these targets, is not that lots of people can't or won't hit them[over 50% DO NOT in my area], but that loads of people who do, think they are protecting themselves from developing complications. So many who could get nearer to normal levels, don't because they don't know what they are.
Even many Healthcare professionals don't know what they are.
I know that I'm the ONLY patient of my health centre who consistently gets HbA1c results in the 5% range.[of hundreds perhaps a couple of thousand] My nurse says it's patients' choice. It's not if they Don't KNOW. So much for informed consent to treatment.
At an event I attended recently, I met a man diagnosed diabetic[T2} 15 years who is losing his sight and has suffered an amputation of a great toe. His Hba1c have been consistently wihin the targets.
It's these targets too which convince many doctors and diabetic specialist nurses that T2 is inevitably progressive.
Since at an HbA1c of 6.5% it's uncontrolled and uncontrolled diabetes is definitely progressive, they are right. However I'm certain that if diabetes is controlled[and it is possible] it does not need to progress.
Another target I hate ios 4mmol/l [72mg/dl] as a dangerous hypo. Most people can function perfectly well at that level, provided their system isn't used to "running high".
Thus a reading at this level to my mind doesn't need teating unless insulin is still in the process of driving it down. Danger level is much lower, probably below 3  The hypo number and the focus on the danger of hypos takes away attention from the much more common danger of consistently HIGH blood glucose. I have tried to find figures for deaths from hypos, but have failed. I know they are an unpleasant experience, but not nearly as dangerous as some people think.Most hypos are mild and easily corrected.
This is a case where the treatment is the problem not the disease itself.
However deaths from kidney failure or the after effects of amputations are big numbers.