David Edelman, MD
Potential Conflicts of Interest: None disclosed.
Edelman D. Time of Exposure and Type of Diabetes May Determine Treatment Outcome of Group Clinics. Ann Intern Med. 2010;153:483. doi: 10.7326/0003-4819-153-7-201010050-00018
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Published: Ann Intern Med. 2010;153(7):483.
We appreciate the thoughtful response from Drs. Porta and Trento. We considered the possibility that hemoglobin A1c levels might be more slowly reactive to interventions than blood pressure and that this could explain why our group medical clinic intervention, compared with usual care, reduced systolic blood pressure but not hemoglobin A1c level. Because we did not follow patients for more than 1 year, we cannot exclude Drs. Porta and Trento's hypothesis that significant differences may have occurred between study groups had we continued the intervention longer. However, our leading hypothesis was that there was more available support, and therefore stronger “usual care,” for blood glucose management than blood pressure management. Two trials by Trento and colleagues (1, 2) also indirectly support this hypothesis.
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