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Independents' Day

A word with Howard

The majority of patients with type 2 diabetes who take oral diabetes drugs remain 'uncontrolled', a study of GP records has revealed.

The research showed that 52 per cent of patients who started a second therapy of oral hypoglycaemic drugs still had high blood glucose levels six months after starting their first therapy.

The researchers branded the management of patients with these drugs 'sub-optimal' and experts said GPs needed to start getting type 2 diabetics on insulin therapy much sooner to achieve the HbA1c target of 7.4 in the QOF.

But concerns over hypoglycaemic attacks with insulin were preventing some GPs from directly getting involved in this treatment, they added.

A study led by Dr Richard McManus, senior lecturer in primary care at the University of Birmingham and a GP in the city, found 'the majority of patients' remained uncontroll-ed six months after the start of oral treatment.

The study, presented to the Society for Academic Primary Care annual meeting earlier this month, identified 20,922 type 2 diabetics prescribed an oral antidiabetic agent, either a sulphonylurea or metformin, over five years.

Of the 2,634 patients who started a second therapy and had HbA1c tested, 1,372 were uncontrolled. Average HBA1c was 7.74 six months after treatment.

Dr McManus said: 'We can see from this that more intensive treatment is required.'

Dr Jonathan Roddick, a GP in Sheffield who helped draw up NICE guidelines on blood glucose management, said: 'The honest answer to this problem is that type 2 diabetes is very difficult to treat. However, the QOF has focused GPs' attention on diabetes.

'One of the other problems is that what a lot of patients with type 2 diabetes need is insulin. There is a large group of people who need insulin but aren't getting it. But things are improving.'

Professor Mike Pringle, professor of general practice at the University of Nottingham, said poor blood glucose control with oral drugs was common in practices. 'Achieving good control often proves very demanding. If lifestyle and medication cannot achieve good control, some patients are suitable for insulin.

'However, that decision needs to be taken case by case. There are no easy answers.'

Professor David Owens, professor of diabetes medicine at the University of Cardiff, said: 'Oral hypoglycaemic agents are time-expired. Currently, very few GPs feel confident to take on insulin therapy. Hypoglycaemia is one of the main fears but there are more stable insulins now.'

By Daniel Cressey

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