Margaret A.WinkerMDIndividualAuthorPhil B.FontanarosaMD, Senior EditorsIndividualAuthor
Copyright 1998 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1998
To the Editor.—The study by Dr Purnell and colleagues1 also has important implications for rethinking the role of intensive glucose control with insulin in type 2 diabetes. Previous clinical trials2,3 and now the study by Purnell et al1 suggest that treatments that raise insulin levels, increase weight and worsen cardiovascular risk factors despite improving glycemia. In 3 European cohorts totaling 17,000 nondiabetic working men, the all-cause mortality was significantly greater for those who had the highest glucose intolerance but not high enough for a diagnosis of diabetes.4 Duration rather than severity of glycemia is a greater risk factor for coronary artery disease (CAD), suggesting a shared underlying pathophysiologic process, endothelial cell dysfunction. Enderle et al5 suggest that a longer period of undetected diabetes rather than poor glucose control impairs endothelial-dependent vasodilatation in type 2 diabetes.
Freedland ES. Excessive Weight Gain and Effects on Lipids With Intensive Therapy of Type 1 Diabetes. JAMA. 1998;280(23):1991-1992. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-23-jbk1216