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To the Editor: We agree with Dr Finney and colleagues¹ that current evidence suggests that higher levels of exogenous insulin do not, in themselves, reduce mortality. However, their conclusion that glucose regulation to levels below 145 mg/dL (8.0 mmol/L) was responsible for the beneficial effect reported was too strong.

In the authors' regression analysis, glucose regulation was stratified as tertiles of time spent in 6 predefined glucose bands. When compared with patients whose majority of glucose levels were above the upper limit of the 111- to 144-mg/dL (6.1-8.0 mmol/L) band, patients in and below this band were more likely to survive. Glucose level, however, is actually a continuous variable. Stratification may entail a loss of information that inflates P values and also may arbitrarily group patients together. By contrast, the authors could have used their data to discover the exact threshold level in a certain population, perhaps by calculating the . . . [Full Text of this Article]

Iwan C. C. van der Horst, MD
i.c.c.horst@int.azg.nl

Rijk O. B. Gans, MD, PhD; Felix Zijlstra, MD, PhD; Jack J. M. Ligtenberg, MD, PhD
Department of Internal Medicine and Cardiology
Groningen University Hospital
Groningen, the Netherlands

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