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Clinical Review Clinical evidence

Glycaemic control in diabetes

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7202.104 (Published 10 July 1999) Cite this as: BMJ 1999;319:104

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Unfortunate timing of glaecemic control in diabetes control review

Is it not unfortunate that Herman limited his review to articles
preceding the September 1998 publications of many of the UKPDS papers
concerning different levels of glycaemic and blood pressure control?

In addition, he does not reference or discuss the Veterans Affairs
Diabetes Feasibility Trial, which showed a trend towards greater risk of
cardiovascular events in the intensive glycemic treatment arm (mean HgbA1c
7.1%) than in the standard treatment arm (mean HgbA1c 9.2%), and the lower
attained HgbA1c level was an independent predictor of cardiovascular
events.

Competing interests: No competing interests

01 August 1999
Willia C Cushman
Chief, Preventive Medicine
Memphis Veterans Affairs Medical Center

UK diagnostic criteria for diabetes are different to the US.

In the Clinical Evidence article ‘Glycaemic Control in Diabetes’ (10
July) the American author states that diabetes is characterised by a
fasting plasma glucose >= 7.0 mmol/L or 2 hour post 75 g oral glucose
load plasma glucose >=11.1 mmol/L (1). While, understandably,
Professor Herman has described the American guidelines for diagnosing
diabetes (2), these are not the same as in the UK. Here, the WHO criteria
are still in use which define the fasting plasma glucose cut off as >=
7.8 mmol/L (3). It is possible in the future that the WHO will adopt the
American Diabetes Association guidelines (4), but in the meantime we have
to be wary of giving clinicians conflicting advice which may lead to
diagnostic difficulties with their patients (5).

References

1. Herman WH. Glycaemic control in diabetes. BMJ 1999; 319: 104-6

2. The Expert Committee on the Diagnosis and Classification of Diabetes
Mellitus. Report of the Expert Committee on the Diagnosis and
Classification of Diabetes Mellitus Diabetes Care 1997; 20: 1183-1197.

3. World Health Organisation. Diabetes Mellitus: Report of a WHO Study
Group. Technical Report Series 727. Geneva: WHO, 1985.

4. Definition, Diagnosis and Classification of Diabetes Mellitus and its
Complications Part 1: Diagnosis and Classification of Diabetes Mellitus
Provisional Report of a WHO Consultation Diabetic Medicine, 1998 15: 539-
553

5. DECODE Study Group. Will new diagnostic criteria for diabetes mellitus
change phenotype of patients with diabetes? Reanalysis of European
epidemiological data. BMJ, 1998; 317: 371-375.

Competing interests: No competing interests

14 July 1999
Eric S Kilpatrick
Consultant in Chemical Pathology
Hull Royal Infirmary
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