Are Continuing Studies of Metabolic Control and Microvascular Complications in Insulin-Dependent Diabetes Mellitus Justified?

The role of intensive therapy with the goal of achieving normal or nearly normal glycemia in patients with insulin-dependent diabetes mellitus has been actively debated.1 2 3 4 The crux of this debate is whether intensive therapy for diabetes can prevent or ameliorate the vascular complications that accompany the disorder. Retinopathy, nephropathy, and neuropathy occur in the majority of patients after they have had diabetes for variable periods. Besides metabolic control, environmental, genetic, and other factors, such as hypertension, have been proposed as risk factors for the development of complications. Although several recent reviews4 , 5 have considered the risks and putative benefits of intensive . . .