Glucose targets: TI responds

We thank Drs Ur and Dawson for their comments on the Therapeutics Letter 68 entitled “Gly­cemic targets in type 2 diabetes.” We agree with their conclusion that “the precise glucose target has yet to be identified.” That in fact is one of the main conclusions of Letter 68. 

In addition, we felt that the ACCORD result showing increased mortality in the <6% HbA1C target group was important and compelling enough to justify reporting at this time. 

The following is our response to each of the other points. 

1. The Letter was not meant to be and does not claim to be a systematic review but rather a des­cription of the two most recent trials looking at glycemic targets.

2. The data we quote and the reference we use are on the NIH ACCORD study web site. We accept that the mortality data reported there are valid as the trialists stopped the study because of these results. 

3. It has been a policy of the TI to not include authors of Therapeutics Letter issues; however, this policy is now under review and may change. The authors of all issues of the Therapeutics Letter are available on request. I am the author of Letter 68 and declare no conflicts. Publication of the Therapeutics Letter is made possible by a grant from the BC Ministry of Health. Letter 68 was sent for expert review to three internists, nine family practitioners, three pharmacists, and others. As is common in peer review, we don’t have permission to release reviewers’ names.  

4. We believe that total mortality outweighs microvascular outcomes, but we did not ignore them. The Letter reports the evidence on microvascular outcomes from the UKPDS trial.

—James M. Wright, MD
On behalf of the Scientific Information and Education Committee
Therapeutics Initiative

James M. Wright, MD, PhD, FRCPC. Glucose targets: TI responds. BCMJ, Vol. 50, No. 5, June, 2008, Page(s) 267 - Letters.

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