DCCT: medical and economical message, five years later

Abstract

Diabetes Control and Complication Trial (DCCT) was a landmark study in the annals of diabetes research. It did firmly establish the importance of achieving near normal glycemia in prevention and/or delay in onset and progression of microangiopathic complications. However, over the last five years since its initial publication, several questions have arisen, especially in terms of long-term medical impact of a higher daily dose of insulin required with intensive therapy, i.e., advent of overt obesity; increasing waist/hip ratios and their potential adverse effects such as hypertension, dyslipidemia and macrovascular disease; necessity of tight control in all diverse populations of diabetes, and the need for intensive therapy for the total duration of diabetes. Moreover, the applicability of DCCT recommendations to subjects with both types is being better accepted worldwide than ever before. Finally, DCCT may have led to zealous efforts in possible prevention and early detection of the disease as well as prompt implementation of appropriate therapeutic strategies to achieve optimal control and further investigation into newer tools for blood glucose monitoring methods of insulin administration and insulin formulations. However, the obviously increased costs of intensive therapy, the lack of knowledge about its long-term cost efficacy and laborious efforts required for intense education of patients and providers of care alike in order to enhance acceptance has made DCCT recommendations difficult. Finally, the process of making the appropriate therapies affordable and available worldwide, including developing countries appears to pose a great challenge even after five years since the advent of DCCT.