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To the Editor: In his Clinical Crossroads article, Dr Abrahamson¹ reviewed medications for intensifying glucose control. We were dismayed by his recommendation for intensive glycemic therapy for a 74-year-old woman with no known microvascular disease. Abrahamson implied that the UK Prospective Diabetes Study (UKPDS) clinical trial provided evidence that intensive glycemic control produces cardiovascular benefit in type 2 diabetes; this is not the case. Reviewers of the epidemiological evidence have concluded that for type 2 diabetes (1) there is no experimental evidence suggesting that improved glycemic control produces cardiovascular benefit (the UKPDS clinical trial found no discernable improvements in diabetes-related mortality, cardiovascular events, vision, renal function, pain, symptomatic peripheral neuropathy, amputations, or quality of life over a 10-year period); (2) the UKPDS found significantly lower diabetes-related mortality, stroke, and visual decline from adding 3 to 4 blood pressure medications in pursuit of tight blood pressure control; and (3) in patients . . . [Full Text of this Article]

Rodney A. Hayward, MD
rhayward@umich.edu

Timothy P. Hofer, MD, MSc; Sandeep Vijan, MD, MSc
VA Ann Arbor
HSR&D Center of Excellence
Ann Arbor, Mich

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ABSTRACT | FULL TEXT