Authors’ reply to Braithwaite

We agree with Braithwaite1 that cardiovascular events are usually acutely defined and generally have an immediate impact on patients’ health, whereas development of diabetes can be insidious and without immediate consequences. The intention of our article2 was to alert clinicians to this adverse development that may pass unnoticed, resulting in devastating complications.The relative importance of cardiovascular benefit or harm of adverse events is a delicate balance. Yet, the impact of these opposing forces is not always comparable: a stroke may be more disabling than hyperglycaemia, whereas diabetic retinopathy resulting in blindness may be more devastating than revascularisation following angina. Between 2009 and 2015, annual emergency department visits for hyperglycaemic crises almost doubled, hospital admissions increased by 73%, and mortality increased by 55%.3Along with Braithwaite, we would love to see a risk calculator that incorporates benefits and risk of harms and predicts cardiovascular benefits as well as risk of dialysis, amputation,…
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