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To the Editor: Dr Jiang and colleagues¹ reported that higher iron stores are an independent risk factor for type 2 diabetes in healthy women. I am concerned that the cases had higher serum ferritin levels at the onset, and differed from controls in other important respects. Compared with controls, cases were more likely at baseline to have a family history of diabetes, an increased body mass index, less physical activity, higher levels of C-reactive protein, and substantially higher levels of insulin and hemoglobin A_1c (mean, 6.4%).

Although the authors did separate analyses to eliminate confounding by some of these other variables, their assertion that the results did not change "when the analyses were restricted to women with hemoglobin A_1c levels of less than 6.5%" does not appear to be substantiated. Furthermore, a hemoglobin A_1clevel cutoff of 6.4% seems high, and thus the authors may have included some patients with . . . [Full Text of this Article]

W. Douglas Trotter, MD
trotter.sfmc@vesgmail.net
Snohomish Family Medical Center
Snohomish, Wash

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