In his article, Dr Havas1 recommends to ignore hyperglycemia in patients with type 2 diabetes mellitus until it becomes symptomatic, and even then he allows the use of metformin only, in addition to diet and exercise. I strongly disagree with his recommendations. I would like to ask Dr Havas if he would prescribe any medicine if a patient has a fasting blood glucose level between 250 and 300 mg/dL (to convert to millimoles per liter, multiply by 0.0555) while following a regimen of diet, exercise, and metformin therapy but is asymptomatic? Roughly what percentage of his patients with diabetes adhere to weight loss and exercise? For how long has he put his strategy into practice, and what kind of results is he seeing on the complications of diabetes in his patients?
Sarfraz Zaidi. Treatment of Type 2 Diabetes: One Extreme to Another. Arch Intern Med. 2009;169(13):1241–1247. doi:10.1001/archinternmed.2009.186