Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor
To the Editor.—Dr Hayward and colleagues1 refer to the relationship between HbA1c
and microvascular disease demonstrated by the Diabetes Control and Complications
Trial Research Group as the basis for exploring effective strategies for improving
glycemic control in individuals with type 2 diabetes.
One of the ways insulin achieves glycemic control is by facilitating
the formation of triglyceride as evidenced by weight gain among the mostly
lean, younger, insulin-dependent diabetes mellitus population of the Diabetes
Control and Complications Trial.2 Even if
we achieve a lower incidence of microvascular disease by glycemic control
through therapy that includes insulin, should we not be concerned about the
association of macrovascular disease with higher lipid levels in the mostly
obese, older type 2 diabetics?
Poothullil JM. Insulin Treatment for Type 2 Diabetes. JAMA. 1998;279(19):1523–1526. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-19-jbk0520