'Difficult' diabetes targets are feasible, UKPDS reveals
GPs will be able to meet challenging diabetes targets in the new GMS contract – but only by intensively monitoring hypertensive diabetics and using combination therapy more widely, a leading diabetes expert has claimed.
Blood pressure levels are already falling in type 2 patients as GPs implement hypertension guidelines, Professor Rury Holman, leader of the UK Prospective Diabetes Study, told the annual Diabetes UK conference last week.
Using multiple anti-hypertensives was key to achieving lower blood pressure levels and reaching quality pay targets, he told Pulse.
New data from a five-year follow-up to the study showed 50 per cent of patients had a systolic blood pressure under 140mmHg, indicating that the quality framework target of 55 per cent of diabetic patients with a blood pressure of 145/85mmHg or below was feasible.
GPs have previously expressed fears that type 2 diabetes patients may be neglected under the new contract because so much effort is needed to hit the 'extremely difficult' quality and outcomes targets.
But Dr Azhar Farooqi, a GP in Leicester and member of the diabetes NSF external reference group, said that while his practice was among the minority that had hit the targets already there was no reason for others not to do the same.
'It requires people to be on a lot of drugs,' he added.
Professor Holman said GPs could hit targets by 'accepting that combination therapy is going to be required for most, if not all, of their hypertensive diabetic patients' and by increasing or adding therapies whenever blood pressure measurements were above targets.
But he warned that blood pressure tended to drift once tight control was relaxed.
In the study, two-thirds of patients underwent intensive quarterly reviews and treatment with ACE inhibitors and/or ß-blockers to maintain tight blood pressure control.
Post-study monitoring showed that within two years of the tight control group returning to routine GP care, mean systolic blood pressure rose to the point where they were indistinguishable from patients in the control group.
By Cato Pedder