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To the Editor.—Dr Purnell and colleagues¹ found that weight gain is associated with increased cardiovascular risk in the group treated with intensive insulin therapy. However, weight gain was associated with a greater increase in total cholesterol and low-density lipoprotein (LDL) cholesterol in the conventional therapy group than in the intensive therapy group, suggesting that treatment and weight gain may have an interactive effect on cholesterol. For example, in the highest quartiles of weight gain, a 13% increase in body mass index (BMI) was associated with a 12% increase in LDL cholesterol in the conventional therapy group. In comparison, a 29% increase in BMI was associated with only a 6.8% increase in LDL cholesterol in the intensive therapy group. However, the authors stated, "Weight gain with conventional therapy resulted in smaller increases in BMI, lipids, and systolic blood pressure."

In the original analysis of the Diabetes Control and Complications Trial . . . [Full Text of this Article]