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Comment & Response
July 11, 2017

Hemoglobin A1c as a Surrogate for Clinical Outcomes in Diabetes Studies—Reply

Author Affiliations
  • 1Section of Endocrinology, Yale School of Medicine, New Haven, Connecticut
  • 2Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
JAMA. 2017;318(2):200-201. doi:10.1001/jama.2017.7225

In Reply We agree with Dr Venker that HbA1c levels were not the same in the placebo and active treatment groups of the EMPA-REG OUTCOME and LEADER trials and appreciate his careful analysis of HbA1c levels over time. However, we still characterize these differences in HbA1c levels as “small.”

In our Viewpoint, we stated that the effects of treatment with empagliflozin and liraglutide on cardiovascular outcomes were “out of proportion” to these small differences in glycemic control levels. This statement is supported by the following evidence.