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For many people, the Diabetes Control and Complications Trial (DCCT) report 15 yr ago ended controversy about the relationship between glucose control and microvascular complications (1). At the time, this debate was a one-piece puzzle, seemingly solved by the study. However, to others, the puzzle was more complex. Because DCCT was a type 1 study, concerns were raised that the weight gain often seen with intensive therapy could result in more cardiovascular events in patients with type 2 diabetes. These concerns were alleviated with the report of the United Kingdom Prospective Diabetes Study (UKPDS) 10 yr ago (2). Like the DCCT, improvements in glycemia resulted in a reduced microvascular burden, but in this older type 2 population, there was also a nonsignificant 16% reduction in myocardial infarctions. Yet another piece to the puzzle was added with a Japanese report confirming the relationship between tight glucose control and microvascular complications. This trial also noted twice the number of macrovascular events in the conventional therapy group as opposed to those intensively managed, but the number of events was small (1.3 vs. 0.6 events per 100 patient-years), as would have been expected in this relatively young cohort (3).

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