Intensive Glucose Control and Cardiovascular Outcomes

Authors' Reply

This publication consists of four letters to the editor of The Lancet, all in response to an article published by Kausik Ray, et al., in The Lancet, suggesting that intensive glucose lowering is beneficial for reducing coronary heart disease (CHD) but not for reducing stroke. The first letter (by Yudkin and Richter) suggests that biases in the data may be exaggerating the benefit of glucose lowering in reducing CHD; their letter also points out that glucose-lowering drugs tend to have more severe side effects than statins and antihypertensive drugs, and can negatively affect quality of life.

The second and third letters (by Lipska, Inzucchi, Kosiborod, and Krumholz, and by Siebenhofer, Jeitler, Pieber and Horvath) question whether the published study, a meta-analysis of several other studies’ data, included studies that really fit the question the authors were trying to answer, and that were comparable to each other. In both letters, the authors suggest that several other studies should have been included; and one letter suggested that previous work showing no macrovascular benefit to intensive glycemic control was ignored. The fourth letter (by Guillausseau) was supportive of the initial study, but suggested that the authors did not adequately emphasize the safety of regimens that intensively lower glucose.

The authors’ reply addresses each letter separately. The authors describe why they included the studies they did, as well as discussing other analyses they performed that supported the conclusions presented in their paper. The authors also point out that other meta-analyses included the same five studies that their analysis included, and explain why space limitations played a role in leaving out some analyses actually performed by the authors that showed the robustness of their conclusions.