Author Affiliations: Division of Endocrinology, Diabetes and Metabolism, Medical Genetics Institute, Cedars-Sinai Medical Center, and Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Dr Goodarzi); and Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, and Center for Health Studies, Group Health, Seattle, Washington (Dr Psaty).
In the 1920s, the use of insulin to treat type 1 diabetes was lifesaving for children in diabetic ketoacidosis. Among the surviving patients with diabetes, the microvascular and macrovascular disease complications proved to be nonetheless devastating. The treatment of type 1 diabetes was revolutionized by the discovery that intensive glycemic control could prevent or delay the development of the microvascular complications of retinopathy, neuropathy, and nephropathy. Indeed, for patients with type 1 diabetes, aggressive insulin treatment also reduced the long-term risk of cardiovascular disease.1
Goodarzi MO, Psaty BM. Glucose Lowering to Control Macrovascular Disease in Type 2 DiabetesTreating the Wrong Surrogate End Point?. JAMA. 2008;300(17):2051-2053. doi:10.1001/jama.2008.510