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.