The National Diabetes Education Program: Changing the Way Diabetes Is Treated

The past few years have been exciting for those of us who treat persons with diabetes. After decades of debate, the evidence that diabetes treatment can prevent or markedly reduce many of the long-term complications of the disease has now become overwhelming. Recent epidemiologic and prospective therapeutic trials examining this hypothesis have found that glycemic control will reduce the microvascular complications of diabetes in patients with either type of the disease (Table). The pivotal trial for patients with type 1 diabetes was the Diabetes Control and Complications Trial, a 10-year trial that was reported in 1993 and sponsored by the National Institutes of Health (1). This trial showed that for every 10% reduction in hemoglobin A_1c, a corresponding 40% reduction occurred in the rate of retinopathy; similar reductions were also found in the rates of nephropathy and neuropathy.

Reduction of complications associated with tight metabolic control in patients with type 2 diabetes was demonstrated in a trial by Ohkubo and colleagues (2). This trial studied Japanese patients, who are less obese and less insulin-resistant than their western counterparts. The debate about whether the results of the Diabetes Control and Complications Trial (1) and the trial by Ohkubo and colleagues (2) applied to western patients with type 2 diabetes was settled by the reporting of the main results of the United Kingdom Prospective Diabetes Study (UKPDS) in September 1998 (4, 5). This long-term prospective trial of more than 5000 patients who had recently received a diagnosis of type 2 …