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March 8, 1995

Effect of Glycemic Control on Early Diabetic Renal Lesions-Reply

Author Affiliations

University of Minnesota Minneapolis

JAMA. 1995;273(10):773. doi:10.1001/jama.1995.03520340027020

In Reply.  —Dr Poothullil questions the evidence supporting glycemia as a risk factor for diabetic complications. Furthermore, he asks whether other measures (such as lipid levels) correlated more closely with the prevention of the structure manifestations of diabetic nephropathy. Unfortunately, in bolstering his claim for a "lack of correlation between a persistent hyperglycemic state and the development of diabetic nephropathy," he has chosen a reference nearly two decades old (his reference 4) that relates to non—insulin-independent diabetes mellitus. In addition to our work showing a strong relationship between glycemic control and the early lesions of diabetic nephropathy in humans,1 the Diabetes Control and Complications Trial (DCCT)2 and other studies3-5 have demonstrated a strong correlation between improved glycemic control and the prevention or reversal of the complications of diabetes. The DCCT demonstrated that lipid levels did not relate as well to the development of complications as did the

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