This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Related letters  • Related article  • Similar articles in JAMA  Topic Collections  • Diabetes Mellitus  • Aging/ Geriatrics  • Alert me on articles by topic

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: In his Clinical Crossroads article, Dr Abrahamson¹ reviewed medications for intensifying glucose control. We were dismayed by his recommendation for intensive glycemic therapy for a 74-year-old woman with no known microvascular disease. Abrahamson implied that the UK Prospective Diabetes Study (UKPDS) clinical trial provided evidence that intensive glycemic control produces cardiovascular benefit in type 2 diabetes; this is not the case. Reviewers of the epidemiological evidence have concluded that for type 2 diabetes (1) there is no experimental evidence suggesting that improved glycemic control produces cardiovascular benefit (the UKPDS clinical trial found no discernable improvements in diabetes-related mortality, cardiovascular events, vision, renal function, pain, symptomatic peripheral neuropathy, amputations, or quality of life over a 10-year period); (2) the UKPDS found significantly lower diabetes-related mortality, stroke, and visual decline from adding 3 to 4 blood pressure medications in pursuit of tight blood pressure control; and (3) in patients . . . [Full Text of this Article]

Rodney A. Hayward, MD
rhayward@umich.edu

Timothy P. Hofer, MD, MSc; Sandeep Vijan, MD, MSc
VA Ann Arbor
HSR&D Center of Excellence
Ann Arbor, Mich

RELATED LETTERS

Intensive Glucose Control in Elderly Adults
Thomas E. Finucane
JAMA. 2007;297(20):2195-2196.
EXTRACT | FULL TEXT  

Intensive Glucose Control in Elderly Adults—Reply
Martin J. Abrahamson
JAMA. 2007;297(20):2196.
EXTRACT | FULL TEXT  

RELATED ARTICLE

A 74-Year-Old Woman With Diabetes
Martin J. Abrahamson
JAMA. 2007;297(2):196-204.
ABSTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

The Effect of Comorbid Illness and Functional Status on the Expected Benefits of Intensive Glucose Control in Older Patients with Type 2 Diabetes: A Decision Analysis
Huang et al.
ANN INTERN MED 2008;149:11-19.
ABSTRACT | FULL TEXT