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Teachable Moment
Less Is More
March 2016

Intensive Glycemic Control in Type 2 Diabetes Mellitus—A Balancing Act of Latent Benefit and Avoidable HarmA Teachable Moment

Author Affiliations
  • 1Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
  • 2Endocrinology Division, Department of Internal Medicine, University Hospital “Dr Jose E. Gonzalez,” Monterrey, Mexico
  • 3Section of Endocrinology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
  • 4Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
  • 5Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
JAMA Intern Med. 2016;176(3):300-301. doi:10.1001/jamainternmed.2015.8320

A 55-year-old construction worker diagnosed as having type 2 diabetes mellitus 5 years ago, with current glycosylated hemoglobin (HbA1c) level of 7.4% of total hemoglobin, was referred to the diabetes clinic to optimize glycemic control. He was obese and had hypertension, dyslipidemia, and obstructive sleep apnea, but no known cardiovascular disease. He was prescribed metformin, 1000 mg twice daily; sitagliptin, 100 mg daily; glimepiride, 4 mg daily; and NPH insulin, 20 U at bedtime. (To convert HbA1c to a proportion of total hemoglobin, multiply by 0.01.)

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