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January 1991

Early Pharmacotherapy in Non-Insulin-Dependent Diabetes Mellitus: Help or Hindrance?

Author Affiliations

Cleveland, Ohio

Arch Intern Med. 1991;151(1):198-201. doi:10.1001/archinte.1991.00400010180033

To the Editor.—  The recent article by Watts and colleagues1 sheds important light on the effects of modest weight loss on glycemic control in obese noninsulin-dependent patients with diabetes mellitus. However, we feel that the authors' data do not support their conclusion and recommendation that their more obese, early diet-failure non-insulin-dependent patients with baseline and more persistent and severe hyperglycemia are better treated early with long-term pharmacotherapy. The authors postulate, without insulin or C-peptide levels mented, that those patients are more severely insulin deficient and imply that early replacement therapy would be more cost effective, less ing, and would avoid the possible damaging effects of persistent hyperglycemia. The axiomatic assertion that long-term good glycemic control can be achieved with insulin therapy in these individuals is not substantiated by the authors' data as follow-up blood glucose levels and glycohemoglobin levels were not provided. Indeed, the authors treated only seven of

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