Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor
Copyright 2002 American Medical Association. All Rights Reserved.
Applicable FARS/DFARS Restrictions Apply to Government Use.2002
In Reply: The ancillary DCCT study that Dr
Poothullil cites does not present a strong argument against achieving tight
glycemic control in diabetic patients when it is associated with weight gain.
Although the subjects who gained the most weight did indeed demonstrate higher
lipid and blood pressure levels, intensive control in the DCCT was still associated
with a trend toward improved cardiovascular outcomes.1
Similarly, sulfonylurea and insulin therapy in the more applicable UKPDS resulted
in both weight gain and a modest trend toward decreased macrovascular events.2 Unfortunately, weight gain frequently accompanies
the achievement of glycemic control with many therapeutic agents, including
sulfonylureas, insulin, and thiazolidinediones. Interestingly, the weight
gain associated with the latter appears to be relegated to the more metabolically
quiescent peripheral sites, while sparing visceral adipose stores,3 and overall, thiazolidinedione therapy appears
to improve cardiovascular risk profiles.4
Thus, I maintain that normalization or near-normalization of blood glucose
concentrations should be a primary goal of therapy for most individuals with
type 2 diabetes, although admittedly its benefits have been easier to demonstrate
for microvascular end points. Weight gain should not dissuade this effort.
Inzucchi SE. Drug Therapy for Patients With Type 2 Diabetes—Reply. JAMA. 2002;287(13):1645-1646. doi:10.1001/jama.287.13.1645