RT Journal
A1 Havas S
T1 Treatment of type 2 diabetes: One extreme to another—reply
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 2009
FD July 13
VO 169
IS 13
SP 1241
OP 1247
DO 10.1001/archinternmed.2009.187
UL http://dx.doi.org/10.1001/archinternmed.2009.187
AB 
Dr Hirsch raises important points. Pharmaceutical companies and the American Diabetes Association (ADA) continue to promote using glucose level–lowering drugs in type 2 diabetes mellitus to attain an HbA1c level below 7% despite recurring evidence of potential harm and scant evidence of benefit. Both influenced the National Committee on Quality Assurance (NCQA) to approve a performance measure for that level.1 Yet randomized clinical trials (RCTs) have not demonstrated significant benefits from glucose level–lowering agents in type 2 diabetes except for metformin. Therefore, it makes no sense for third-party payers to hold practitioners to a non–evidence-based measure of an HbA1c level below 7%.