Evidence exists from study of non-insulin dependent diabetes in Japan Editor-In his editorial prompted by the publication of the DIGAMI (diabetes mellitus, insulin glucose infusion in acute myocardial infarction) trial, 1 Malcolm Nattrass states that (in non-insulin dependent diabetes) "evidence [is] still awaited for a relation between diabetic control and microvascular complications." 2 It is true that we all await with interest the results of the United Kingdom prospective diabetes study, but some evidence does already exist. Although it is not directly relevant to Nattrass's editorial, in other contexts I have been surprised that it is rarely discussed and is almost never referenced in publications written by authors working on diabetes outside Asia and Australasia. The study to which I refer is the Kumamoto study. 3 This randomised 110 patients with non-insulin dependent diabetes (half with existing microvascular complications and half without) into a group treated with multiple injections and a group given normal care. After six years of follow up, both retinopathy and nephropathy were convincingly less common in the group treated with multiple injections-both the primary prevention cohort and the secondary prevention cohort. While I do not necessarily advocate this trial as definitive evidence of the same effect as that in the diabetes control and complications trial in non-insulin dependent diabetes, it seems a pity that it is discussed so rarely outside Asia and Australasia. This may be due to failure on our part to take note of studies published in journals from other continents. It may also be due to reservations, on the part of those who do know about the study, about whether results obtained in Japanese patients (who were, for example, not obese) also apply to populations of patients that might have different characteristics and different therapeutic responses. Rhys Williams Professor of epidemiology and public health Nuffield Institute for Health, Leeds LS2 9PL 1 Malmberg K for the DIGAMI Study Group. Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus.