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What Is the Best Way to Treat Diabetes?

Medical controversies last a long time and are often bitter not only because science gives provisional rather then definitive answers to most questions, any of which answers may soon be overturned by further evidence, but because science by itself provides no means of deciding between incommensurable results according to a single criterion of value. Besides, everyone likes a good intellectual argument and wants to keep it going as long as possible.

An editorial in a recent edition of the New England Journal of Medicine claims that the long-running controversy over whether surgery or angioplasty is better for diabetic patients with ischaemic heart disease has now been decisively resolved in favor of the former, thanks to a paper published in the same edition. The matter is not a small one: in the United States alone 175,000 diabetic patients were treated last year either with surgery or angioplasty, and the figure is likely to rise as the number of diabetics grows.

The paper described a trial in which 947 diabetic patients with ischaemic heart disease underwent surgery and 953 underwent angioplasty (there were no untreated controls). At five years, mortality in the angiolasty group was 16.3 percent as against 10.9 percent in the surgical group; in total 26.6 percent of those treated with angioplasty had either died or had had a stroke or heart attack, as against 18.7 percent of the surgical group.