Dramatic advances in the care of the diabetic patient have taken place in the last few years. The driving force has been the recognition that strict control of diabetes should prevent the long-term complications.1 As a result, new techniques have been developed, eg, the portable infusion pump and home glucose level monitoring, that permit more aggressive insulin therapy. Diabetes will not be cured until investigators solve the problems of immune rejection and miniaturization of an artificial pancreas. However, current techniques do allow for "normalization" of the diabetic patient.
Evidence that the control of blood glucose levels prevents the dreaded complications of diabetes comes partly from animal studies. Islet cell transplants from normal rats to littermates that had been made diabetic have prevented and even reversed the typical lesions of nephropathy.2 In human studies, improvement in several factors of renal function has been achieved in diabetic patients by intensive