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To the Editor: In their Research Letter, Dr Horlen and colleagues¹ reported a high frequency of inappropriate metformin prescriptions in patients with type 2 diabetes. However, because of the way in which they ascertained pharmacological treatment, their results grossly overstate the risks to these patients. Horlen et al simply recorded whether patients had a diagnosis of congestive heart failure (CHF) and were also taking a diuretic, an angiotensin-converting enzyme (ACE) inhibitor, or digoxin. Given the high frequency of hypertension in patients with type 2 diabetes (up to 60% in some series) and the relatively high frequency of elevated levels of urinary albumin excretion, it is likely that many of these patients were taking these drugs for the treatment of hypertension or albuminuria. I do not know if the authors confirmed that these drugs were being used for the treatment of CHF and not other causes in these patients, but the . . . [Full Text of this Article]

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