Intensive therapy of type 2 diabetes (ACCORD trial)

To the Editor: I certainly enjoyed Dr. Byron J. Hoogwerf’s excellent summary article regarding intensive therapy of type 2 diabetes. I was concerned, however, about the sentence in his last paragraph stating that “any strategy that lowers glucose and is not associated with a risk of hypoglycemia and does not cause excessive weight gain should be considered appropriate in patients with type 2 diabetes.” This statement begs the question: What is excessive weight gain?

In view of the known adverse effects of obesity on hypertension, lipid disorders, and insulin resistance, how can any weight gain be beneficial? Is there any evidence that lowering glucose has any benefit when it is associated with weight gain?