Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You and Your Team.

Learn More →

Diabetic Polyneuropathy and Glucose Control

Diabetic Polyneuropathy and Glucose Control 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. Back to top Article Information Financial Disclosures: None reported. References 1. Rutkove SB. A 52-year-old woman with disabling peripheral neuropathy: review of diabetic polyneuropathy JAMA. 2009;302(13):1451-145819738078PubMedGoogle ScholarCrossref 2. Genuth S. Insights from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study on the use of intensive glycemic treatment to reduce the risk of complications of type 1 diabetes. Endocr Pract. 2006;12:(suppl 1) 34-4116627378PubMedGoogle ScholarCrossref 3. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352(9131):837-8539742976PubMedGoogle ScholarCrossref 4. Patel A, MacMahon S, Chalmers J, et al; ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358(24):2560-257218539916PubMedGoogle ScholarCrossref 5. Duckworth W, Abraira C, Moritz T, et al; VADT Investigators. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360(2):129-13919092145PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Diabetic Polyneuropathy and Glucose Control

JAMA , Volume 303 (5) – Feb 3, 2010

Loading next page...
 
/lp/american-medical-association/diabetic-polyneuropathy-and-glucose-control-0NsqrnxqqR
Publisher
American Medical Association
Copyright
Copyright © 2010 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2010.55
Publisher site
See Article on Publisher Site

Abstract

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. Back to top Article Information Financial Disclosures: None reported. References 1. Rutkove SB. A 52-year-old woman with disabling peripheral neuropathy: review of diabetic polyneuropathy JAMA. 2009;302(13):1451-145819738078PubMedGoogle ScholarCrossref 2. Genuth S. Insights from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study on the use of intensive glycemic treatment to reduce the risk of complications of type 1 diabetes. Endocr Pract. 2006;12:(suppl 1) 34-4116627378PubMedGoogle ScholarCrossref 3. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352(9131):837-8539742976PubMedGoogle ScholarCrossref 4. Patel A, MacMahon S, Chalmers J, et al; ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358(24):2560-257218539916PubMedGoogle ScholarCrossref 5. Duckworth W, Abraira C, Moritz T, et al; VADT Investigators. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360(2):129-13919092145PubMedGoogle ScholarCrossref

Journal

JAMAAmerican Medical Association

Published: Feb 3, 2010

References