ABSTRACT
The Diabetes Control and Complications Trial (DCCT) definitely proved that the microvascular complications of type 1 diabetes mellitus could be prevented or delayed by improving glucose control (1). Since the publication of this study, the aim for therapy of individuals with type 1 diabetes has been to achieve glucose and A1c values as close to normal as safely possible (2). However, the DCCT and follow-up study, Epidemiology of Diabetes Interventions and Complications (EDIC), also proved how difficult it was to attain and maintain normoglycemia (1,3). Despite considerable support from diabetologists, diabetes educators and registered dieticians, the average A1c in the subjects randomized to the intensive group of the DCCT was 7.2%, far above the goal A1c of less than or equal to 6.05%. Moreover, less than 5% of the intensive cohort was able to maintain average A1c at or below target (1). One year after the end of the intensive intervention of the DCCT study, the average A1c in the intensive group rose to 7.7%, approaching the level of 8.1% in the conventional group. The differences between the groups continued to narrow over the next 5 years (3). One decade after the publication of the DCCT study results, glycemic control, as measured by A1c, has improved in people with type 1 diabetes. An Australian study of 1335 children with type 1 diabetes reported improvement in average A1c from 10.9% in 1992 to 8.1% in 2002 (4). Several recent studies report similar findings, with average A1c levels ranging between 8.2% and 9.0% (5-7), far higher than the targets set by the American Diabetes Association.
