Editor's Correspondence |

Changing the Diabetes Treatment Paradigm

Ronald Hirsch, MD
Arch Intern Med. 2009;169(13):1241-1247. doi:10.1001/archinternmed.2009.185.
Text Size: A A A
Published online


As an internist with a busy office practice and a large number of patients with type 2 diabetes mellitus, I was flabbergasted to read the Commentary by Havas1 on the lack of evidence supporting pharmacologic control of blood glucose levels and his recommendation that metformin be the sole oral agent used. Achieving a hemoglobin A1c (HbA1c) level below 7.0% is considered the sole measure of adequate diabetic control, and failure to achieve that mark is considered failure to adequately care for the patient. In fact, Medicare has included HbA1c control as one of its core measures for diabetes care in the recently enacted Physician Quality Reporting Initiative.2 Patients are routinely treated with multiple oral agents at a great expense, which only increases when we add injectable agents to the mix to achieve that elusive goal of an HbA1c level less than 7.0%. They endure adverse effects like nausea and diarrhea, which we pass off as nuisances, and risk hypoglycemia, which could have catastrophic effects. When we suspect that patients are not adherent with their prescribed treatment regimen and have an HbA1c above 7.0%, we consider discharging them from our practices so our data do not look bad. And yet Dr Havas now advocates controlling blood glucose for only the most extreme cases and concentrating our efforts on blood pressure and cholesterol control.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview





Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 1

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles