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In Reply: The brief format of the Contempo Updates section allowed us only to mention the many hypotheses put forth to explain the documented benefits of insulin and glycemic control in acutely ill patients. Research is active in this field—we may need to await innovative studies that consider patient important outcomes, which can distinguish whether the benefits of intensive glycemic control with insulin are due to the former or the latter.

Victor M. Montori, MD, MSc; M. Molly McMahon, MD
Division of Endocrinology, Metabolism, Nutrition, and Internal Medicine
Mayo Clinic and Mayo Medical School
Rochester, Minn

Bruce R. Bistrian, MD, PhD
Department of Medicine
Harvard Medical School
Boston, Mass

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289:1244.

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