Managing People at High Risk for Diabetes
Authors: David M. Eddy, Leonard Schlessinger, Richard Kahn
Journal: Annals of Internal Medicine (2006)

Letters3 January 2006Managing People at High Risk for DiabetesDavid M. Eddy, MD, PhD, Leonard Schlessinger, PhD, and Richard Kahn, PhDDavid M. Eddy, MD, PhDFrom Kaiser Permanente, Pasadena, CA; Kaiser Permanente, Oakland, CA 94611; and American Diabetes Association, Alexandria, VA 22307., Leonard Schlessinger, PhDFrom Kaiser Permanente, Pasadena, CA; Kaiser Permanente, Oakland, CA 94611; and American Diabetes Association, Alexandria, VA 22307., and Richard Kahn, PhDFrom Kaiser Permanente, Pasadena, CA; Kaiser Permanente, Oakland, CA 94611; and American Diabetes Association, Alexandria, VA 22307.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-144-1-200601030-00019 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We are pleased to address the issues raised by Dr. Herman and his colleagues. Concerning glycemic progression, they are correct that we used UKPDS data to help build our model. We see that as a strength, not a weakness. The resulting model accurately simulates the progression of diabetes across the entire time horizon of our analysis—from impaired fasting glucose and impaired glucose tolerance (it independently predicted the rates in the Diabetes Prevention Program) through to clinical diabetes and for at least 15 years thereafter.Dr. Herman and associates argue for a faster rate of glycemic progression. They assume ...References1. Herman WH, Hoerger TJ, Brandle M, Hicks K, Sorensen S, Zhang P, et al. The cost-effectiveness of lifestyle modification or metformin in preventing type 2 diabetes in adults with impaired glucose tolerance. Ann Intern Med. 2005;142:323-32. [PMID: 15738451] LinkGoogle Scholar2. Harris MI, Klein R, Welborn TA, Knuiman MW. Onset of NIDDM occurs at least 4-7 yr before clinical diagnosis. Diabetes Care. 1992;15:815-9. [PMID: 1516497] CrossrefMedlineGoogle Scholar3. Thompson TJ, Engelgau MM, Hegazy M, Ali MA, Sous ES, Badran A, et al. The onset of NIDDM and its relationship to clinical diagnosis in Egyptian adults. Diabet Med. 1996;13:337-40. [PMID: 9162609] CrossrefMedlineGoogle Scholar4. Jarrett RJ. Duration of non–insulin-dependent diabetes and development of retinopathy: analysis of possible risk factors. Diabet Med. 1986;3:261-3. [PMID: 2951182] CrossrefMedlineGoogle Scholar5. Eddy DM, Schlessinger L. Validation of the Archimedes diabetes model. Diabetes Care. 2003;26:3102-10. [PMID: 14578246] CrossrefMedlineGoogle Scholar6. Ratner R, Goldberg R, Haffner S, Marcovina S, Orchard T, Fowler S, et al. Impact of intensive lifestyle and metformin therapy on cardiovascular disease risk factors in the diabetes prevention program. Diabetes Care. 2005;28:888-94. CrossrefMedlineGoogle Scholar7. Geiss LS, Herman WH, Smith PJ. Mortality in non–insulin-dependent diabetes. In: Harris MI, Cowie CC, Stern MP, et al., eds. Diabetes in America. 2nd ed. Washington, DC: National Diabetes Data Group, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 1995:233-58. NIH publication no. 95-1468. Available at diabetes.niddk.nih.gov/dm/pubs/america/pdf/chapter11.pdf. Google Scholar Author, Article, and Disclosure InformationAuthors: David M. Eddy, MD, PhD; Leonard Schlessinger, PhD; Richard Kahn, PhDAffiliations: From Kaiser Permanente, Pasadena, CA; Kaiser Permanente, Oakland, CA 94611; and American Diabetes Association, Alexandria, VA 22307.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Cost-Effectiveness of Lifestyle Modification or Metformin in Preventing Type 2 Diabetes in Adults with Impaired Glucose Tolerance William H. Herman , Thomas J. Hoerger , Michael Brandle , Katherine Hicks , Stephen Sorensen , Ping Zhang , Richard F. Hamman , Ronald T. Ackermann , Michael M. Engelgau , and Robert E. Ratner , for the Diabetes Prevention Program Research Group*Clinical Outcomes and Cost-Effectiveness of Strategies for Managing People at High Risk for Diabetes David M. Eddy , Leonard Schlessinger , and Richard Kahn Managing People at High Risk for Diabetes William H. Herman , Thomas J. Hoerger , Katherine Hicks , Michael Brandle , Stephen W. Sorensen , Ping Zhang , Michael M. Engelgau , Richard F. Hamman , David G. Marrero , Ronald T. Ackermann , and Robert E. Ratner Metrics Cited byEconomic Evaluation of Lifestyle Interventions for Preventing Diabetes and Cardiovascular DiseasesIs prevention of Type-2 diabetes feasible and efficient in primary care? 3 January 2006Volume 144, Issue 1Page: 67-68KeywordsBlood pressureClinical trialsDiabetes preventionGlucoseGlucose intoleranceHbA1cMyocardial infarctionPopulation statisticsRetinopathyRisk management ePublished: 3 January 2006 Issue Published: 3 January 2006 Copyright & PermissionsCopyright © 2006 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...