As a nurse and a type I diabetic, I have read this thread with a great deal of interest. From a personal standpoint, living in a rural community (read 10 years behind the times of urban areas), my doctor does the A1C q 3 months, and the ACE inhibitors as preventative care. He also does lipid profiles q 6 months (a little more often than recommended). His treatment of me seems to be always geared toward tightening control without hypoglycemia, and the recommendations of the ADA for prevention.
BUT, in the last 20 years as I think back on my diabetic care, I have had a microalbumin recommended and done by a doctor only once, and that was part of a complete physical, not as a diabetic screening. During that time I have lived in 4 different states, with different doctors, of course.
As for insulin resistance (by doctors and patients, not the physiological kind), most would rather run a little high and take a pill than get under better control with insulin. My doc hesitantly says, 'we could do X, Y,Z, but you'd have to have another shot a day . . .' and then looks forlorn because he already thinks I wouldn't do it. Of course, he is pleasantly surprized when I readily agree and start implementing his suggestions. But, I'm not the average diabetic patient, either.
Just one patient's experience in the US.