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Ziemer and colleagues¹ demonstrate "clinical inertia" in the primary care treatment of type 2 diabetes mellitus. As a primary care provider, I would like to suggest another reason that many physicians failed to "do enough" to meet guideline targets: tight control in type 2 diabetes fails to show much benefit. The data from all relevant randomized controlled trials are presented in tabular form by the US Preventive Services Task Force.²

The vaunted reduction in microvascular events in the United Kingdom Prospective Diabetes Study (UKPDS) consisted almost entirely of a reduction in laser treatment of the retina from 11 to 8 per 100 patient-years.² Except for the metformin arm of UKPDS, death rates were the same or higher in patients who were assigned to tight control. (All package inserts for sulfonylureas carry a black box warning, required by the Food and Drug Administration, about a doubling of cardiovascular death in treated . . . [Full Text of this Article]

AUTHOR INFORMATION
Thomas E. Finucane, MD

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RELATED LETTER

The Dogma of "Tight Control": Beyond the Limits of Evidence—Reply
David C. Ziemer and Lawrence S. Phillips
Arch Intern Med. 2006;166(15):1672.
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An Intervention to Overcome Clinical Inertia and Improve Diabetes Mellitus Control in a Primary Care Setting: Improving Primary Care of African Americans With Diabetes (IPCAAD) 8
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