Intensified diabetes management: lessons from the diabetes control and complications trial

Abstract

The results of the multicenter diabetes control and complications trial are examined and methods for the implementation of the findings for individuals with type I and type II diabetes are discussed. More than a decade ago the question was raised of whether tight glycemic control would prevent or slow the progression of microvascular complications. In 1993, having studied 1441 individuals with type I diabetes randomized to either intensive glycemic control (HbA1c < 7%) or conventional glycemic control (HbA1c > 9%), it was concluded that a reduction in risk of retinopathy, neuropathy and nephropathy could be realized if near normal glycemic control were achieved. Some questions remained, however. For example, could intensive treatment be achieved in routine practice under the auspices of primary care physicians? Are the findings in this study applicable to individuals with type II diabetes? These questions are addressed through the introduction of staged diabetes management (SDM), an innovative approach to the treatment of diabetes and the prevention of its complications. SDM is designed as a data-based systematic approach to diabetes treatment that targets blood glucose control. Studied in 40 clinical sites throughout the United States and evaluated in 30 sites worldwide, SDM promises to provide appropriate clinical guidance to both primary care and specialist physicians seeking to alter current practice patterns by adopting a systematic approach to diabetes management.