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May 20, 1998

Insulin Treatment for Type 2 Diabetes

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(19):1523-1526. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-19-jbk0520

To the Editor.—We read with interest the report by Dr Hayward and colleagues1 regarding the treatment of type 2 diabetes in a large staff-model health maintenance organization. However, several issues concern us. Most troublesome are conclusions drawn from comparisons between 2 groups of patients (insulin treated and non–insulin treated) that were not generated by randomization and that therefore may differ in ways other than insulin treatment. In fact, it is very likely that patients started on insulin by their physicians are different as a group than those not treated with insulin by those same physicians. Observations of differences in treatment effectiveness, complications, and resource utilization between these groups are necessarily affected by the underlying group differences.

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