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In Reply: Dr Hayward and colleagues and Dr Finucane suggest that a 74-year-old woman with type 2 diabetes and well-controlled hypertension, who has no other co-morbid conditions and who has an expected life expectancy of another 13 years, should not be encouraged to achieve an HbA_1c value closer to normal. In my article, I stated that the UKPDS showed that "intensive" treatment of participants with type 2 diabetes treated with sulfonylureas and insulin resulted in a 16% relative reduction in risk for myocardial infarction that did not reach statistical significance (P = .052). I agree that further data are needed to support the benefit of intensive glucose control for cardiovascular outcomes in people with type 2 diabetes, even though there is now compelling evidence that improved glycemic control in type 1 diabetes significantly reduces the risk for cardiovascular morbidity.^1-2

However, strong evidence indicates that improved glycemic control in type 2 . . . [Full Text of this Article]

Martin J. Abrahamson, MB, CHB
martin.abrahamson@joslin.harvard.edu
Joslin Diabetes Center
Beth Israel Deaconess Medical Center
Boston, Mass

RELATED LETTERS

Intensive Glucose Control in Elderly Adults
Rodney A. Hayward, Timothy P. Hofer, and Sandeep Vijan
JAMA. 2007;297(20):2195.
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Intensive Glucose Control in Elderly Adults
Thomas E. Finucane
JAMA. 2007;297(20):2195-2196.
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