[Diabetes mellitus: the role of metabolic control in the prevention of complications].

Recent studies have cast doubt on the idea, generally agreed but not unequivocally proven, that optimal control of diabetes could delay or prevent the development of late microangiopathic complications of the disease. In particular, a perfect equilibration of glycemic values could, in certain cases, deteriorate, rather than improve, the situation (pre-proliferative retinopathy). Through a review of literature the authors try to answer the following questions: is diabetic microangiopathy due to hereditary factors? Can the treatment of diabetes influence the appearance of late "triopathic" complications? If yes, could an optimal metabolic control result in a stop or a regression of these lesions? Based on the available data, the authors reach the conclusion that yes, it is worthwhile to treat correctly diabetes mellitus and, if possible, a perfect glycemic control should be sought. There are only few and well determined exceptions to this rule. In insulin dependent diabetics a perfect control can presently be obtained by means of conventional intensified insulin treatment (multiple injections) or of continuous subcutaneous insulin infusion (insulin pump) for variable periods of time.