Since the introduction of insulin therapy, which transformed type 1 diabetes mellitus from a uniformly fatal disease to a chronic degenerative one, persons with type 1 diabetes have experienced a litany of long-term complications resulting in loss of vision, renal failure, foot ulcers and amputations, and a heightened risk of cardiovascular disease. The demonstration by the Diabetes Control and Complications Trial that near-normal glucose level control decreases the microvascular and cardiovascular complications has heralded a new era of diabetes care. This study describes the current-day outcomes that patients with type 1 diabetes can expect with conventional therapy and intensive therapy. After 30 years of diabetes, 22%, 9%, and 9% of intensively treated patients developed proliferative retinopathy, advanced nephropathy, and cardiovascular disease, respectively. Fewer than 1% lost vision (<20/200), required a kidney transplant or dialysis, or had an amputation because of their diabetes. The remarkable improvement in long-term outcomes should inform clinicians and patients alike to implement intensive diabetes therapy as early in the course of diabetes as possible.