INTENSIFIED DIABETES MANAGEMENT - LESSONS FROM THE DIABETES CONTROL AND COMPLICATIONS TRIAL

The results of the multicenter diabetes control and complications tria l 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 randomi zed to either intensive glycemic control(HbAlc < 7%) or conventional g lycemic control (HbAlc > 9%), it was concluded that a reduction in ris k of retinopathy, neuropathy and nephropathy could be realized if near normal glycemic control were achieved. Some questions remained, howev er. For example, could intensive treatment be achieved in routine prac tice under the auspices of primary care physicians? Are the findings i n this study applicable to individuals with type II diabetes? These qu estions are addressed through the introduction of staged diabetes mana gement (SDM), an innovative approach to the treatment of diabetes and the prevention of its complications. SDM is designed as a data-based s ystematic approach to diabetes treatment that targets blood glucose co ntrol. Studied in 40 clinical sites throughout the United States and e valuated in 30 sites worldwide, SDM promises to provide appropriate cl inical guidance to both primary care and specialist physicians seeking to alter current practice patterns by adopting a systematic approach to diabetes management.