@Jenny, I still think that suggesting a flaw of the study is that the control group wasn't selected to have excellent blood sugars reflects a fundamental misunderstanding of what this study, and for that matter all studies like it, are intended to do. I'm sorry if that comes across as condescending.
I agree that some doctors seem to erroneously tell patients they don't need to address their diabetes. More likely, many seem to be willing to compromise at levels higher than ones that what lots of us here think is both achievable and warranted.
The study we're discussing has its limitations. It's far from the only study regarding GCK-MODY, but it seems to be among the best on that topic. I certainly don't take away from it the message that anyone, myself included, can ignore their A1c.
I agree there's some shoddy science out there. But, at the risk of being condescending, the argument that "doctors are very bad at understanding statistics" seems a bit rich under the circumstances. In particular, I have a hard time buying the argument that both the Kovler and the Exeter researchers, the two centers of excellence for research on MODY, are both either inept or corrupt.
My assessment is rooted in part in the Kovler folks' responses to my posing some of the same questions you are posing. But I continue to be interested in understanding these issues better, in part because they have potentially huge implications for my own health, but also because I'm intellectually fascinating by them.
I observe, consistent with other studies, that an intensive insulin regimen (which I did for 13 years) at most very modestly lowers my glucose levels, and it comes along with at least sporadic lows that have their own downsides. I would be very surprised if I went back on insulin in the near-term, absent the development of corresponding more traditional T1 or T2 dynamics on top of my GCK-MODY mutation.
Most oral meds also make little sense given my condition, e.g. I present with high insulin sensitivity. But if my numbers were to worsen down the road and/or depending on what drugs come down the pipeline, there are some interesting options that might help address the specific GCK mutation-mediated pathology I have.
Low carb can curb post-prandial spikes, and I agree with you it's plausible, and there's some evidence, that this is highly desirable. Low carb can also have some, albeit limited, effect on reducing my average blood sugars. I've never eaten a really high-carb diet, and certainly not since I was diagnosed as diabetic thirteen years ago. I will play around with diet, and I suspect I'll end up at a low-ish but not super low place. I find severe low carb impacts my athletic performance, which is very important to me, though I wonder whether my body might adapt over time.
I do think you are asking some very good questions and making some good points. Obviously I also think some are less good, but I don't have to agree with everyone you write to value your contribution, any more than you have to agree with everything I write. And even where I disagree with you, you've helped me better develop my own opinions, and I appreciate that.