BMJ 2001;322:1245 ( 19 May )

Letters

Glycaemia and vascular effects of type 2 diabetes

    Lowering glucose concentrations may not be of any value in itself
    UKPDS is not a cohort study and analysis is misleading
    Relation between diabetes and hyperglycaemia and cardiovascular disease has not been resolved
    Authors' reply

Lowering glucose concentrations may not be of any value in itself

The first 150 words of the full text of this article appear below.

EDITOR---Stratton et al have documented that as glycaemic exposure increases, diabetic complications increase.1 They conclude that treatment of hyperglycemia will have substantial benefit, a conclusion reiterated by Tuomilehto.2 Yet reduction of glycaemic exposure did not have such benefit in the UK prospective diabetes study (UKPDS) randomised trial. 3 4 The data by Stratton et al suggest that reducing mean haemoglobin A1C concentration by 1% would reduce diabetes related deaths by 21%. Intensive treatment of hyperglycaemia for 10 years in UKPDS reduced haemoglobin A1C by nearly 1% (from 7.9% to 7.0%) yet did not reduce diabetes related deaths significantly.

The conventionally treated group, with greater glycaemic exposure, experienced diabetes related death at a rate of 11.5 deaths per 1000 person years. On the basis of the data by Stratton et al, the intensively treated group should have experienced diabetes related death at a rate of 9.0 deaths per 1000 person years. Intensive treatment was, however, associated . . . [Full text of this article]
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