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Huge variations in the treatment of type 2 diabetes are revealed by a new study, with researchers blaming confusing and inadequate guidelines.

The study found stark differences in the use of ACE inhibitors, ?-blockers and statins in patients with diabetes, although they also recorded a steady increase in overall levels of prescribing.

The researchers concluded GPs were allowed too much leeway in choosing antihypertensive drugs and that stricter guidelines were necessary.

But GP diabetes experts warned any extra guidance could further confuse matters and that GPs were faced with conflicting evidence on the value of different drugs.

The proportion of patients with type 2 diabetes who received an ACE inhibitor varied from 15 to 81 per cent in different practices, while ?-blocker use ranged from 5 to 60 per cent. Use of statins varied from 0 to 50 per cent, although the landmark CARDS trial and British Heart Protection Study now suggest all patients with type-2 diabetes could benefit from the drugs.

Lead researcher Dr Martin Gulliford of the Department of Public Health Sciences, King's College London, suggested 'more universal pharmacotherapy' could cut down on 'wide clinical practice variations and ineffective treatment'.

He added: 'Greater standardisation in the management of hypertension in diabetes could lead to better outcomes for subjects with diabetes and hypertension.'

But Dr Eugene Hughes, Isle of Wight GP and Primary Care Diabetes Society member, said antihypertensive use was already changing and added: 'Every trial that comes out seems to suggest something else and the last thing we need is any more guidelines.'

Dr Hughes said the consensus was that GPs should combine sub-maximal doses of each antihypertensive agent to bring patients' blood pressure down to 130/80mmHg or less.

The study, published in the Journal of Human Hypertension (January), examined data for 4,519 patients with diabetes started on oral hypoglycaemic drugs between January 1993 and December 2001.

While the variations in drug use were dramatic, the overall use of antihypertensive drugs went up. The proportion of hypertensive patients with diabetes who were prescribed thiazide diuretics increased from 20 to 30 per cent; ACE inhibitors from 35 to 45 per cent and angiotensin receptor blockers from 0 to 8 per cent.

By Cato Pedder

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