I am a part of several diabetes support groups and I finally found what I was looking (it started me researching the glucose spike issue). Here is an online post from a Joslin Medalist that talks about a recent meeting he attended and the last paragraph he mentions the problem of having lots of highs and lows. Ultimately though, like Samson pointed out, genetics must play a larger role and may triumph even in strict management. Stephen Ponder posted about the variability in the A1C being a factor and linked this article: http://www.healio.com/endocrinology...thy-nephropathy-in-teens-with-type-1-diabetes Long Term Success With Type 1 Diabetes- by Richard Vaughn "I have been type 1 for 70 years, and I do not have any serious diabetes related complications. While participating in the Joslin medalist type 1 study in Boston, I was told that several participants freely admitted that they have not taken good care of themselves. They eat a lot of food containing sugar, and other fast acting carbs. Despite their bad eating habits, they do not have any complications after many years of type 1. All of the 1000+ participants have been type 1 for at least 50 years, and are US citizens. I was also told by the lady in charge during my participation that several participants have used tight control, but have experienced some serious complications. These are the exceptions to the rule. The majority of the participants in this study have done at least reasonably well with their control, and they do not have any serious complications. In the Joslin Medalist Study, Dr. George King, head of the study, did discuss the "special inner protection" that so many medalists have. He said that this mysterious protection seems to protect us against serious problems with our eyes, kidneys, and our nervous systems,but not our hearts. He wanted us to know that we should take every precaution to keep our hearts healthy. There is a secret group on Facebook called "The Joslin Medalists" where many members have posted about their stents, bypass surgeries, heart attacks, etc...but these same people have good eyesight and healthy kidneys. After almost 60 years of type 1, I was diagnosed with spots of retinopathy, and neuropathy. My A1c had been in the range 5.4-6.0 for many years, but I still had these complications. My control involved too many highs and lows, a roller coaster type of control. Those highs and lows can produce an average which is quite good, so the A1c will also be good. That can give us a sense of false security. The roller coaster control is traumatic to our bodies, and complications can result, even though the A1c is good. I started pumping insulin in 2007, and my control was much more stable, with not so many highs and lows. The retinopathy disappeared, and has been gone for nine years. The neuropathy is still present, but it rarely bothers me now. Avoiding complications seems to require a good A1c, and more stability with not so many highs and lows. If I had started pumping in the 1990's I may not have had any complications at all. I read an article a few years ago that said the life expectancy of young type 1 diabetics in the US is almost as good as for non diabetics. That is very encouraging news!!"