De l'inertie clinique aux complications

The incubation time for diabetes complications is long - in the order of at least a decade if the glycaemic imbalance remains persistently high. Both the duration and severity of the imbalance are important : glycaemic intoxication is accumulative, rather like smoking intoxication, making it possible to speak of 'pack-years', but in relation to diabetes. The mechanisms of the metabolic debt are as yet poorly understood, but they are probably multiple and involve slow reversible epigenetic modifications. Clinical inaction allows the burden of vascular complications to set in, but correcting such inertia should not prompt a rush towards clinical interventions, given their possible harmful effects as observed in large interventional trials.