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April 10, 1995

The Benefits of Tight Glycemic Control in Diabetes MellitusFor the Many or for the Few?

Author Affiliations

Welch Center for Prevention, Epidemiology, and Clinical Research The Johns Hopkins Medical Institutions 2024 E Monument St Suite 2-600 Baltimore, MD 21205-2223

Arch Intern Med. 1995;155(7):665-667. doi:10.1001/archinte.1995.00430070015002

THE RESULTS of randomized trials are expected to influence clinical practice. When the results of the Diabetes Control and Complications Trial (DCCT) were published in 1993,1 there was every reason to expect a dramatic influence on the care of individuals with insulin-dependent diabetes mellitus (IDDM). This well-designed, carefully conducted, multicenter study provided convincing evidence that intensive glycemic control cut the risk of progression of retinopathy, nephropathy, and neuropathy in half compared with usual care.1 Tight glycemic control in the intensively treated group was achieved by aggressive insulin therapy, careful glucose monitoring, and close dietary supervision implemented by a multidisciplinary team of health professionals. In response to the DCCT, one would have expected a sharp increase in referral to well-staffed diabetes units prepared to reproduce this intensive regimen. Instead, there are early indications that no such increase has materialized (New York Times. February 28, 1994;section A:1).

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