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.)
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Rodriguez-Gutierrez R, Lipska KJ, McCoy RG. Intensive Glycemic Control in Type 2 Diabetes Mellitus—A Balancing Act of Latent Benefit and Avoidable Harm: A Teachable Moment. JAMA Intern Med. 2016;176(3):300–301. doi:10.1001/jamainternmed.2015.8320
Coronavirus Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.