I think the article raises an interesting discussion. First they raise the question of tight control but they never define what they mean by tight control. Then they question the value of T2 meds.
The article says "We have taken for granted or assumed that the evidence was very clear that if you control you blood sugars tightly, you will prevent diabetes complications," Montori said. "The answer is less clear than expected and, as a result, it would suggest that our thinking about it may have been flawed."
Gary Scheiner in "Think like a pancreas" defines very tight as 60-160 and tight as 70-180. Three years ago I would have agreed with him but with CGMs and monomer insulin I would revise them to 70-140 and 70-150.
Now, what T2 med is designed to keep that control? The answer is none. All but insulin treat high BG indirectly. I suspect that meal time spikes 180+ is typical for most T2s. Then it takes hours to come down below 140 and we know BG 140+ for even a few hours causes microvascular damage. We also know 70%+ are not meeting the 7.0 A1c target.
And then they say "We know, for instance, that the higher the blood sugar the higher the risk of heart attacks, the higher the risk of cancer, the higher the risk of strokes," Gerstein said. "But whether other things related to the diabetes are causing those things is not known."
The short answer is in some cases the T2 meds are the cause. Orinase came on the market in 1957 and it took 13 years before the reports started coming out about it causing heart attacks. Then it was not withdrawn until 2000. We have had 44 new diabetes drugs approved since 2005 with most targeting T2s. Avandia did not work out so well. I see one TV commercial after the next by lawyers looking for Invokana users. Trulicity and the rest could very well follow the same route but only time will tell.
Knowing these T2 meds are not going to keep meal time spikes under 140 or even 150 or 160 what value are they really having? Metformin for example, demonstrated a 31% reduction in three-year incidence of development of diabetes relative to a placebo but was outdone by the lifestyle-modification arm of the same trial which demonstrated a 58% reduction.
Unless the T2 is going to use mealtime insulin to address the spike and keep A1cs in the 5's or below I tend to agree with the article. The T2 meds may be causing more harm than good and the T2 should be cutting carbs and walking more.