Summary
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 macro-vascular 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.
Key words
DCCT - Medical and economic impact - implementation
