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Stephen Havas, MD, MPH, MS

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

In reply

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 HbA_1c 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 HbA_1c level below 7%.

Since my commentary was published,² the Veterans Affairs Diabetes Trial (VADT) results appeared, providing further RCT evidence of the lack of benefit of lowering HbA_1c levels.³ The VADT randomized veterans with poorly controlled type 2 diabetes to intensive control or standard . . . [Full Text of this Article]

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