Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus
Authors: Thibault Richard, Dany Brohee, Alain Van Meerhaeghe, Michel Vanhaeverbeek
Journal: Annals of Internal Medicine (2012)

Letters3 July 2012Oral Pharmacologic Treatment of Type 2 Diabetes MellitusThibault Richard, MD, Dany Brohee, PhD, Alain Van Meerhaeghe, MD, and Michel Vanhaeverbeek, MDThibault Richard, MDFrom CHU Charleroi, Hopital Vésale, 6110 Montigny-le-Tilleul, Belgium.Search for more papers by this author, Dany Brohee, PhDFrom CHU Charleroi, Hopital Vésale, 6110 Montigny-le-Tilleul, Belgium.Search for more papers by this author, Alain Van Meerhaeghe, MDFrom CHU Charleroi, Hopital Vésale, 6110 Montigny-le-Tilleul, Belgium.Search for more papers by this author, and Michel Vanhaeverbeek, MDFrom CHU Charleroi, Hopital Vésale, 6110 Montigny-le-Tilleul, Belgium.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-157-1-201207030-00018 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:In the recent ACP clinical guideline (1), Qaseem and colleagues recommend the addition of a second agent in patients with persistent hyperglycemia despite metformin use and lifestyle modifications (Grade: strong recommendation, high-quality evidence). We do not agree with this level of recommendation.Our main concern is that the superiority of dual therapy over metformin alone has only been validated by use of a surrogate outcome (that is, the HbA1c level). There are many examples in recent years of evidence founded on surrogate end points, which provide no benefit—or even harm—to patients when hard end points are considered. ...References1. Qaseem A, Humphrey LL, Sweet DE, Starkey M, Shekelle P; Clinical Guidelines Committee of the American College of Physicians. Oral pharmacologic treatment of type 2 diabetes mellitus: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2012;156:218-31. [PMID: 22312141] LinkGoogle Scholar2. Montori VM, Fernández-Balsells M. Glycemic control in type 2 diabetes: time for an evidence-based about-face? Ann Intern Med. 2009;150:803-8. [PMID: 19380837] LinkGoogle Scholar3. Hemmingsen B, Lund SS, Gluud C, Vaag A, Almdal T, Hemmingsen C, et al. Intensive glycaemic control for patients with type 2 diabetes: systematic review with meta-analysis and trial sequential analysis of randomised clinical trials. BMJ. 2011;343:d6898. [PMID: 22115901] CrossrefMedlineGoogle Scholar4. UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998;352:854-65. [PMID: 9742977] CrossrefMedlineGoogle Scholar5. Gerstein HC, Miller ME, Byington RP, Goff DC, Bigger JT, Buse JB, et al; Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358:2545-59. [PMID: 18539917] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From CHU Charleroi, Hopital Vésale, 6110 Montigny-le-Tilleul, Belgium.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoOral Pharmacologic Treatment of Type 2 Diabetes Mellitus: A Clinical Practice Guideline From the American College of Physicians Amir Qaseem , Linda L. Humphrey , Donna E. Sweet , Melissa Starkey , Paul Shekelle , and Metrics 3 July 2012Volume 157, Issue 1Page: 76KeywordsBiomarkersConflicts of interestHbA1cHyperglycemiaProspective studiesSafetySafety studiesType 2 diabetes ePublished: 3 July 2012 Issue Published: 3 July 2012 Copyright & PermissionsCopyright © 2012 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...