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Clinical Review State of the Art Review

Benefits and harms of intensive glycemic control in patients with type 2 diabetes

BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l5887 (Published 05 November 2019) Cite this as: BMJ 2019;367:l5887

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Re: Benefits and harms of intensive glycemic control in patients with type 2 diabetes

the first reason of this comment is to congratulate with the Authors for this timely, complete and balanced review. I would hope to anticipate a correction of several misleading guidelines that still emphasise strict glucose control as a mantra of therapy of T2DM . A lower blood glucose target means more drugs, more controls, more expenses and more side effects and burden for society and Patients. May be it is time to change vision on glucose control: a moderate target should become a first choice and not a rescue strategy for higher values. Since high prevalence of T2DM consideration of cost should be mandatory in the choice of drug. Looking at SGLT2 I think that their prevalent action is a diuretic one and should be used in Patients with HF. The second reason of my comment is to raccomend to do not put together control of hyperglycaemia in hospital setting with every day life. No doubt that control of blood glucose and use of insulin are of critical importance for recovery of infected surgery Patients

Competing interests: No competing interests

10 November 2019
renzo cordera
prof of Endocrinology
University of Genova
viale Benedetto XV -6 Genova Italy 16128