Progress in Diabetes Research—What's Next

KEYWORDS:
• BLOOD GLUCOSE
• BLOOD GLUCOSE SELF-MONITORING
• CARDIOVASCULAR DISEASES
• DIABETES MELLITUS
• DIABETES MELLITUS, TYPE 1
• DRUG THERAPY
• GLYCEMIC INDEX
• HEMOGLOBIN A, GLYCOSYLATED
• HYPOGLYCEMIA
• METFORMIN
• RESEARCH

The pandemic of diabetes threatens to overwhelm clinicians' collective ability to treat the associated metabolic abnormalities and long-term complications. Yet even in the setting of the pandemic, clinical research has yielded remarkable progress that has improved the long-term prognosis of diabetes.

The Diabetes Control and Complications Trial (DCCT) and its long-term follow-up definitively established hyperglycemia as the—or at least a—major cause of complications of diabetes by demonstrating that intensive therapy achieving a glycated hemoglobin (HbA_1c) level of approximately 7% reduced the development and progression of retinopathy, nephropathy, and neuropathy by 30% to 76%, compared with conventional treatment that achieved an HbA_1c level of approximately 9%.¹ The long-term follow-up results have demonstrated that the relative benefits of intensive therapy persist for at least 10 years after the end of the intensive intervention, even after the HbA_1c levels in the treatment groups converged, a phenomenon termed “metabolic memory.”^{2, …}