To the Editor: In his Clinical Crossroads article discussing diabetic polyneuropathy in a patient with type 2 diabetes, Dr Rutkove1 stated that improved glucose control should be recommended to all patients with that diagnosis, citing the Diabetes Control and Complications Trial (DCCT) that was conducted in patients with type 1 diabetes.2 He also cited 2 case series in type 1 diabetes as support that tight control can improve symptoms quickly.
Three randomized controlled trials (RCTs) in type 2 diabetes (UKPDS 33,3 ADVANCE,4 and VADT5 ) have shown that tight control did not benefit diabetic neuropathy. In the largest of these,4 with more than 10 000 patients, there was a non–statistically significant increase in new or worsening neuropathy in the tight control group.
Extrapolating evidence from type 1 diabetes to the treatment of type 2 diabetes is a foundation for the continuing strong belief in tight control. The RCTs, however, suggest that this belief is a mistake.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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