Response to DCCT: How Sweet Is It?

Abstract

From the lack of increased referral to diabetic centers, it would appear that practicing physicians drew greatly different conclusions from the Diabetes Control and Complications Trial (DCCT) than did Brancati 1 as described in his editorial The Benefits of Tight Glycemic Control in Diabetes Mellitus. To me, the DCCT report showed that there is excellent justification for tight glycemic control in insulin-dependent diabetics, that patients should be encouraged to intensively monitor their blood glucose levels and adjust their dosage of insulin to maintain near normalization of the blood glucose levels as manifested by the hemoglobin A 1C , and that careful attention should be paid to diet. This confirmed my impression of state-of-the-art management of diabetes. I extrapolated that the same conclusions might apply to non—insulin-dependent diabetics and that aggressive management is probablyjustified. Nowhere did I draw from the DCCT the conclusion that tight diabetic control in a well-staffed diabetic unit