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摘要

DrHirsch 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, providingfur-ther 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 care. The intensive control group attained a mean HbA_(1c) level of 6.9% compared with 8A% in the standard care group, with a mean follow-up of 5.6 years. The trial failed to demonstrate reductions in macrovascular complications, micro-vascular complications, and all-cause mortality.