The Diabetes Control and Complications Trial Study: implications for the diabetic foot.

The pathogenesis of foot problems in patients with diabetes mellitus involves multiple factors including macrovascular disease, microvascular disease, abnormalities in blood flow distribution, peripheral neuropathy, autonomic neuropathy, physical stress, and infection. Surprisingly, the role of poor glycemic control in the development of diabetic foot complications has not been well studied. Recently, the Diabetes Control and Complications Trial has provided conclusive evidence that hyperglycemia plays a major role in the development of microvascular complications. Because the etiologic factors that contribute to microvascular complications also play an important role in foot complications, one would expect that tight glycemic control, however achieved, would be effective in both the primary and secondary prevention of diabetic foot problems.