Implications and results of the Diabetes Control and Complications Trial.

After almost 60 years of debate, the DCCT demonstrated that intensive management that is able to lower blood glucose and HbA1c to levels that are close to normal markedly lowers the risk for and progression of the microvascular and neuropathic complications of IDDM. The challenge to pediatricians and other clinicians is to achieve and maintain such stringent treatment goals in children and adolescents, who are especially difficult to manage, without causing an unacceptably high rate of severe hypoglycemia. Translation of DCCT recommendations into clinical practice is best accomplished by multidisciplinary teams who are experienced in the management of young patients with IDDM and are willing to use the variety of unconventional treatment regimens that may be required. Patients and families must be instructed on ways to reduce the risk for hypoglycemia and be able to recognize and treat hypoglycemic events that require assistance. New agents, such as insulin lispro, may enhance the ability to achieve strict glycemic control, but the treatment remains a burden. Nevertheless, in patients in whom treatment is successful, the improvement in long-term prognosis more than justifies the investment in time, effort, and resources.