Glucose targets

The Therapeutics Initiative has recently addressed the issue of glucose control and its impact on diabetes complications.[]

While we commend the TI for their attention to this important area, we have significant concerns regarding their methodology and conclusions.

1. The authors provide no description of their literature search and their criteria for inclusion/exclusion.

2. Much of the evidence they quote is taken from a press release; i.e., unpublished data that are not peer reviewed.

3. The authors do not identify themselves, their expert reviewers, or their potential conflicts of interest. 

4. The authors have ignored evidence that a lower glucose target reduces retinopathy, nephropathy, and other small vessel complications of diabetes.

Whilst we agree that the precise glucose target has yet to be identified, it is unhelpful and premature to make definitive statements until publication later this year of results for ACCORD, as well as two other studies looking at glucose control and macrovascular outcomes: ADVANCE and the VADT trial.

For further information we recommend the Canadian Diabetes Association web site at

—Ehud Ur, MB 
—Keith Dawson, MD 


1. Therapeutics Initiative. Glycemic targets in type 2 diabetes. Therapeutics letter 68. Jan-Feb 2008.

Ehud Ur, MBBS, FRCPC, Keith G. Dawson, MD, PhD, FRCPC. Glucose targets. BCMJ, Vol. 50, No. 5, June, 2008, Page(s) 243 - Letters.

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