Glycemic control and the complications of diabetes: Afer the diabetes control and complications trial

Although the discovery of insulin extended and improved the lives of individuals with insulin-dependent diabetes mellitus, it soon became clear that the long-term complications of diabetes would result in considerable morbidity and mortality. Before 1993, research suggested a relationship between glycemic control and diabetic complications. Data derived from experimental diabetes in animals indicated that controlling hyperglycemia could prevent the subsequent development of diabetic retinopathy and nephropathy. In humans, however, many of the data were collected retrospectively and before the availability of glycosylated hemoglobin measurements. Prospective clinical trials were relatively small and of short duration and consisted of patients with various characteristics. Not surprisingly, results were inconclusive. The Diabetes Control and Complications Trial, a 10-year prospective multicenter trial of >1,400 patients, convincingly demonstrated that intensive insulin therapy designed to achieve near-normoglycemia significantly reduced the risk for the development and progression of the microvascular complications of diabetes. Although intensive diabetes treatment requires a greater commitment of resources, the associated reduction in microvascular complications makes intensive therapy cost-effective over the long term. The health care system should support intensive diabetes treatment for appropriate diabetic patients.