Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor
To the Editor.—We are intrigued by the
data of Dr Hayward and colleagues1on the
treatment of type 2 diabetes by generalists, but we question their conclusions.
They found mean hemoglobin A1c(HbA1c) levels in all
patients to be 8%, better than in earlier studies. Sixteen percent of patients
not taking insulin initially began insulin and had 0.9% lower HbA1c
levels a year later. Despite this improvement, 60% of these patients failed
to reach an 8% (0.08) HbA1clevel that indicated acceptable control.
Short-term costs of starting insulin included a few more visits and tests
and a 4-fold increase in glucose self-testing.
Riddle MC, Karl DM. Insulin Treatment for Type 2 Diabetes. JAMA. 1998;279(19):1523–1526. doi:10.1001/jama.279.19.1523