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Open Journal of Internal Medicine, 2011, 1, 80-92 OJIM doi:10.4236/ojim.2011.13017 Published Online December 2011 (http://www.SciRP.org/journal/ojim/) Diabetes: a pragmatic therapy with a goal to prevent end stage kidney disease and dialysis Anil KMandal1,2, Nirankar Singh Neki3,4 1Consultant in Nephrology Putnam Community Medical Center, Palatka, USA; 2 Courtesy Clinical Professor of Medicine, University of Florida, Gainesville, USA; 3Professor of Medicine Government Medical College, Amritsar, India; 4Geriatric Society of India, New Delhi, India. Email: amandal@ ; drnsneki_123@ Received 22 August 2011; revised 24 September 2011; accepted 2 November 2011. ABSTRACT which is to keep patients learn to cope with diabetes and thrive. Randomized clinical trials of glycemic The pragmatic therapy of diabetes which is to achi- control comparing one insulin against another, or in- eve satisfactory glycemic control emerges from au- sulin against oral hypoglycemic agents is not ethical. thor’s laboratory research. Cell culture studies con- Such clinical trials will shed no light in improving vincingly demonstrated that high glucose levels above diabetes care. On the other hand, it may prove to be 200 mg/dL ( 11.1 mmol/L) cause damage to vascular detrimental. endothelial cells. The severity of damage increases with duration of exposure of cultured endothelial cells Keywords: Diabetes; Paradigm Of Therapy; Postprandial to high glucose. This glucose-induced endothelial cell Hyperglycemia; Endothelial Cell Injury; Insulin Treat- damage is