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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