Does strict metabolic control prevent long‐term diabetic complications?

Although insulin has been in use for 65 years, it is still not kn„n whether strict metabolic control can prevent long‐term diabetic complications. There are two major reasons for this: conventional insulin treatment is unable to normalise or near‐normalise blood glucose levels; and until recently there were no methods for long‐term monitoring of blood glucose. During the last decade infusion pumps and pens have been marketed which enable us to simulate the endogenous insulin secretion and thereby normalise or near‐normalise blood glucose levels and home blood glucose monitoring methods are widely available. Therefore, it should n„ be possible to test the hypothesis that strict metabolic control prevents long‐term diabetic complications. This paper reviews the results of six prospective, controlled, randomised, clinical trials which have been published. The consensus is that near‐normalisation of blood glucose levels is able to retard or arrest the progression of long‐term diabetic complications.