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To the Editor: The study of activation of oxidative stress in patients with type 2 diabetes by Dr Monnier and colleagues¹ identifies an interesting association between glycemic variability and oxidative stress. However, it is important to highlight some limitations of the tools used in this study and the data reported.

Continuous glucose monitoring systems (CGMSs) may be inaccurate or even intermittently fail to record. The authors report the accuracy of CGMSs for a single fasting time point but do not report whether a minimum accuracy criterion was applied prior to accepting a 24-hour glucose profile, such as a maximum permitted mean relative absolute difference between all concurrent CGMSs and capillary glucose measurements, or a maximum gap in the CGMS recording.

The study examined only 1 marker of oxidative stress, urinary 8-iso prostaglandin F₂ (8-iso-PGF₂). Although most studies demonstrate elevated urinary 8-iso-PGF₂ in patients with diabetes, some studies have indicated . . . [Full Text of this Article]

Kevin B. Moore, MD
kmoore30@jhmi.edu
Division of Endocrinology and Metabolism
Johns Hopkins University
Baltimore, Md

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