September 10, 1997

Clinical Crossroads Update: A 65-Year-Old Man With Poorly Controlled Type 2 Diabetes Mellitus

Author Affiliations

Johns Hopkins University School of Medicine Baltimore, Md

JAMA. 1997;278(10):820-821. doi:10.1001/jama.1997.03550100046031

To the Editor.  —The 1-year follow-up of a patient with diabetes1 struck me as misguided. Dr Rubenstein had presented a rationale for the effective management of type 2 diabetes. In this follow-up, the now 65-year-old patient returned 4 kg heavier, with even worse glycemic control (blood glucose level, 14.4 mmol/L [260 mg/dL]; glycohemoglobin, 11.8%), and highrisk dyslipidemia.Despite this overall worsening of the patient's risk for complications, the patient and physician appear complacent. Things are going well, the patient is playing tennis, he can allegedly tell when he is out of control, and an optometrist found no subjective visual impairment (not exactly the way to assess retinopathy). "The patient did not want to take insulin." It all reminds me of the line about a man jumping from a 27-story skyscraper, waving to each window as he goes by, saying "Feeling fine so far."The evidence is beyond question that