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Letters to the Editor  |   April 2011
New Therapeutic Options: Management Strategies to Optimize Glycemic Control
Author Affiliations
  • David A. Sisam, DO
    Department of Endocrinology, Terrebonne General Medical Center, Houma, Louisiana
Article Information
Endocrinology / Diabetes
Letters to the Editor   |   April 2011
New Therapeutic Options: Management Strategies to Optimize Glycemic Control
The Journal of the American Osteopathic Association, April 2011, Vol. 111, 300. doi:10.7556/jaoa.2011.111.4.300
The Journal of the American Osteopathic Association, April 2011, Vol. 111, 300. doi:10.7556/jaoa.2011.111.4.300
To the Editor:  
I read the March 2010 supplement to JAOA—The Journal of the American Osteopathic Association titled “Advances in Diabetes Management: Slowing Disease Progression” with great interest. However, I was concerned about the following statement made by Jeffrey S. Freeman, DO, in his article on management strategies for optimizing glycemic control1: “Traditional antihyperglycemic agents—thiazolidinediones and sulfonylureas—often fail to maintain glycemic goals long-term, in part, because they do not target the underlying pathophysiologic processes of T2DM [type 2 diabetes mellitus].” 
I disagree with this statement. Results of the United Kingdom Prospective Diabetes Study (UKPDS)2 clearly showed that diet modification, sulfonylureas, metformin, and insulin did not slow β-cell failure. However, A Diabetes Outcome Progression Trial (ADOPT)3 clearly showed that rosiglitazone maleate did slow β-cell failure, compared to sulfonylureas and metformin. 
I do agree with Dr Freeman's position that incretins are an excellent class of drugs for sustained glycemic control.1 Incretins probably also prevent β-cell failure, which I believe is the way of the future in terms of trying to alter the course of diabetes mellitus progression. 
For the sake of balance, I felt that these points needed to be published. 
Freeman JS. New therapeutic options: management strategies to optimize glycemic control. J Am Osteopath Assoc. 2010;110(3 suppl 2):S15-S20.
Turner RC, Cull CA, Frighi V, Holman RR; for the UK Prospective Diabetes Study (UKPDS) Group. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49). JAMA. 1999;281(21):2005-2012.
Viberti G, Kahn SE, Greene DA, et al. A diabetes outcome progression trial (ADOPT): an international multicenter study of the comparative efficacy of rosiglitazone, glyburide, and metformin in recently diagnosed type 2 diabetes. Diabetes Care. 2002;25(10):1737-1743.