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Editor's Correspondence
July 13, 2009

Treatment of Type 2 Diabetes: One Extreme to Another—Reply

Arch Intern Med. 2009;169(13):1241-1247. doi:10.1001/archinternmed.2009.187

In reply

Dr Hirsch raises important points. Pharmaceutical companies and the American Diabetes Association (ADA) continue to promote using glucose level–lowering drugs in type 2 diabetes mellitus to attain an HbA1c level below 7% despite recurring evidence of potential harm and scant evidence of benefit. Both influenced the National Committee on Quality Assurance (NCQA) to approve a performance measure for that level.1 Yet randomized clinical trials (RCTs) have not demonstrated significant benefits from glucose level–lowering agents in type 2 diabetes except for metformin. Therefore, it makes no sense for third-party payers to hold practitioners to a non–evidence-based measure of an HbA1c level below 7%.