Abstract
THE RESULTSof 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). See also page
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