BMJ  2007;334:1236 (16 June), doi:10.1136/bmj.39234.451296.3A

Letters

Rosiglitazone and heart deaths

Glycaemic control is a myth

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

Tight control of HbA1c levels has been enshrined in the QOF (quality and outcomes framework) of the new general practitioner contract as being an evidence based proposal. Multiple drugs are licensed on the understanding that they reduce HbA1c levels and that this is a good thing. So should it surprise us that a meta-analysis of trials of rosiglitazone shows a raised risk of myocardial infarction and an increase in cardiovascular deaths?1

The reduction in diabetes related end points, mortality and stroke from using metformin is not explicable on the basis of glycaemic control.2

The data of UKPDS 33, which compared tight glycaemic control with sulphonylureas or insulin with conventional treatment, showed little benefit from tight control.3 The outcomes that did show some clinical benefit were cataract extractions, retinal photocoagulation, and non-fatal myocardial infarction and all cause mortality—that is, if you can call absolute risk reductions of between 1 and 3 . . . [Full text of this article]

Illtyd R Thomas, general practitioner

Swansea SA1 5LF

illtyd.thomas@gp-w98027.wales.nhs.uk


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Rapid Responses:

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Glycaemic control is not a myth
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There are more important interventions than glycaemic control.
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