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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The study by Chan et al¹ sought to estimate the incidence of acute liver failure (ALF) and injury unrelated to other causes among patients with diabetes mellitus treated with oral agents or insulin. Several shortcomings in their analysis and presentation of the data promote an inaccurate understanding of the issue of acute liver failure and non-ALF acute liver injury (ALI) in patients receiving treatment for diabetes.

The most serious problem relates to the definition of ALF used by the authors and given in Table 2 of their article.¹ The essential feature of ALF, separating it from less severe ALI, is the presence of encephalopathy.^2-3 Without encephalopathy, a patient does not have ALF, yet for purposes of their analysis, results, and conclusions, the authors classified patients without encephalopathy as having "possible" ALF and combined them with a much smaller number of patients with actual ALF. Of the 35 patients forming the . . . [Full Text of this Article]

David J. Graham, MD, MPH
Rockville, Md

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