The DCCT and Medical Care for Diabetes in the U. S.

The Diabetes Control and Complications Trial (DCCT) has convincingly established that intensive treatment of insulin-dependent diabetes mellitus (IDDM) can substantially reduce the incidence and progression of retinopathy, nephropathy, and neuropathy (1). Development of retinopathy in those without retinopathy at baseline was reduced by 76%, and progression of retinopathy in those with early retinal disease at baseline was reduced by 54%. Intensive therapy was associated with a 39% reduction in the occurrence of microalbuminuria (≥40 mg of urine albumin per 24 h) and a 54% reduction in the incidence of albuminuria (≥300 mg of urine albumin per 24 h). Development of clinical neuropathy was reduced by 60%. A reduction also occurred in macrovascular disease events (41%), although this did not reach statistical significance.