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For the Many or for the Few?

Frederick L. Brancati, MD, MHS

Arch Intern Med. 1995;155(7):665-667.

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THE RESULTS of randomized trials are expected to influence clinical practice. When the results of the Diabetes Control and Complications Trial (DCCT) were published in 1993,¹ there was every reason to expect a dramatic influence on the care of individuals with insulin-dependent diabetes mellitus (IDDM). This well-designed, carefully conducted, multicenter study provided convincing evidence that intensive glycemic control cut the risk of progression of retinopathy, nephropathy, and neuropathy in half compared with usual care.¹ Tight glycemic control in the intensively treated group was achieved by aggressive insulin therapy, careful glucose monitoring, and close dietary supervision implemented by a multidisciplinary team of health professionals. In response to the DCCT, one would have expected a sharp increase in referral to well-staffed diabetes units prepared to reproduce this intensive regimen. Instead, there are early indications that no such increase has materialized (New York Times. February 28, 1994;section A:1).

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Author Affiliations
Welch Center for Prevention, Epidemiology, and Clinical Research The Johns Hopkins Medical Institutions 2024 E Monument St Suite 2-600 Baltimore, MD 21205-2223

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