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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.—The report by Dr Hayward et al1 and the Editorial by Dr Colwell2 are important contributions that indicate that effective treatment of patients with type 2 diabetes is difficult and not easily achieved. The essence of this report is that the care provided did not enable patients to achieve the recommended American Diabetes Association guidelines for glycemic control.2 Table 2 demonstrates that 19% did not have an HbA1c level measured and only 32% of those who did achieved glucose control. However, the report omits important details. Who helped the patients acquire the necessary education, understanding, and practice to be responsible for their care? Insulin doses reported were low and significantly less than those (1.0 U/kg) adequate for control of type 2, insulin-resistant patients.3 Yet these patients, at considerable cost (10-12 visits, more laboratory tests, more glucose test strips), probably fared better than those in the general population.

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