Excess Mortality Associated With Diuretic Therapy in Diabetes Mellitus

To the Editor. —  Recently, Warram et al¹ concluded that intervention with diuretics to reduce hypertension is associated with excess mortality in diabetic patients with and without proteinuria. Until there is a clinical trial showing a beneficial effect of diuretic treatment in diabetic patients, there is urgent need to reconsider its continued usage in this population.These conclusions were based on a retrospective analysis of diabetic patients (mainly insulin users) participating in a multicenter clinical trial of laser therapy. This important sudy of severe diabetic retinopathy was carried out between 1972 and 1979.For a number of reasons, I would like to challenge the conclusion and the recommendation that was made above. First, the authors recognize that they have no information on the specific diuretic or nondiuretic drug applied, the dosage, treatment period, and compliance. Second, indication for diuretic use is lacking— hypertension? heart disease? edemas? Third, the trial