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November 26, 1997

Controlling Type 2 Diabetes Are the Benefits Worth the Costs?

Author Affiliations

From the Department of Medicine, Medical University of South Carolina, Charleston.

JAMA. 1997;278(20):1700. doi:10.1001/jama.1997.03550200076036

Ever since the publication of the Diabetes Control and Complications Trial,1 health care professionals, people with diabetes, administrators, and governmental agencies have been concerned about translation of the findings into clinical practice. The study showed that an intensive approach to glycemic regulation, which entailed frequent visits and contact with a health care team, can produce a significant improvement in hemoglobin A1c (HbA1c) levels in people with type 1 diabetes, and can lower the risk for progression of retinopathy from 50% to 75%, depending on the end points chosen. In addition, significant lowering of the risk for progression of albuminuria and sensory neuropathy was achieved. Some of the major issues have been:

1. Should these results be applied to people with type 2 diabetes?

2. What are the guidelines for levels of HbA1c that should lead to action, and what is the target level to achieve?

3. Can