Intensive insulin therapy in insulin-dependent diabetes mellitus, the results of the diabetes control and complications trial.

Long term complications are the first causes of mortality and morbidity in diabetic patients. In Europe, many diabetologists speculated for a long time that a tight blood glucose control was the best way to avoid these complications, but without any complete evidence. In 1993, the results of the Diabetes Control and Complications Trial (DCCT), the first controlled, randomized, long term trial designed to study the link between metabolic control and complications in a large cohort of patients, has confirmed this hypothesis: in insulin-dependent diabetes mellitus, intensive insulin-therapy, as compared with conventional therapy, significantly reduces the risk of developing microvascular and neuropathic complications. Nevertheless, in some patients, the risk of hypoglycemia may outweight the benefit of intensive insulin therapy, and the results of the DCCT raises some questions about indications, the risk/benefit ratio and the cost/benefit ratio of intensive treatment.