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To the Editor: Discussing a 74-year-old woman with diabetes, Dr Abrahamson¹ noted that " . . . no studies have evaluated the impact of intensive glucose control in individuals older than 60 years."¹ He could have added that no studies have evaluated the effect of intensive control with rosiglitazone or the effect of this combination of antidiabetic drugs. Nonetheless, when this patient taking a combination of metformin, glyburide, and rosiglitazone had a HbA_1C value of 6.9%, the rosiglitazone dose was doubled, and the discussion centered on the variety of other drugs that can be added later when needed for intensive control.

The actual evidence for the benefits of intensive glucose control in any group of patients with type 2 diabetes mellitus is limited, as shown in a review of all randomized clinical trials.² One effect of intensive glucose control, reported in UKPDS 34, was significantly increased risk of diabetes-related death associated with early addition . . . [Full Text of this Article]

Thomas E. Finucane, MD
tfinucan@jhmi.edu
Division of Geriatric Medicine & Gerontology
Johns Hopkins Bayview Medical Center
Baltimore, Md

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