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Letters
May 23/30, 2007

Intensive Glucose Control in Elderly Adults

Author Affiliations
 

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;297(20):2195-2196. doi:10.1001/jama.297.20.2195-a

To the Editor: In his Clinical Crossroads article, Dr Abrahamson1 reviewed medications for intensifying glucose control. We were dismayed by his recommendation for intensive glycemic therapy for a 74-year-old woman with no known microvascular disease. Abrahamson implied that the UK Prospective Diabetes Study (UKPDS) clinical trial provided evidence that intensive glycemic control produces cardiovascular benefit in type 2 diabetes; this is not the case. Reviewers of the epidemiological evidence have concluded that for type 2 diabetes (1) there is no experimental evidence suggesting that improved glycemic control produces cardiovascular benefit (the UKPDS clinical trial found no discernable improvements in diabetes-related mortality, cardiovascular events, vision, renal function, pain, symptomatic peripheral neuropathy, amputations, or quality of life over a 10-year period); (2) the UKPDS found significantly lower diabetes-related mortality, stroke, and visual decline from adding 3 to 4 blood pressure medications in pursuit of tight blood pressure control; and (3) in patients who were overweight (>120% of ideal body weight), treatment with metformin monotherapy was associated with reduced diabetes-related mortality and microvascular outcomes, while monotherapy with insulin or sulfonylureas was not, despite similar levels of glycemic control.24 Additionally, and of particular concern for those considering intensifying therapy, combination oral therapy (metformin plus sulfonylurea) was associated with higher diabetes-related mortality.2

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