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At the heart of general practice since 1960

PCTs survive first year of new contract

On reading the article 'New evidence sparks diabetes scripts surge' (News, March 26) I am concerned that a misleading message suggesting 'the lower the glucose the better' will be reinforced in your readers' minds.

Indeed, Dr Patel, a GP with an interest in diabetes, is quoted as saying the increase in use of hypoglycaemic drugs 'reflected very well on GPs that they responded so fast to UKPDS'.

UKPDS actually showed that only metformin was associated with a decrease in diabetes-related and overall mortality, irresepective of the degree of blood glucose control.

Conversely, treatment of overweight patients with type 2 diabetes with insulin or sulphonylurea drugs has no effect on microvascular or macrovascular outcomes.

UKPDS actually showed that tight blood glucose control had no effect on diabetes-related or overall mortality. Furthermore, diabetic patients with hypertension benefit more from good blood pressure control than good blood glucose control.

For these reasons, in addition to treating all obese patients with metformin, GPs should prioritise the following interventions in order of decreasing priority for their patients with type-2 diabetes: smoking cessation, blood pressure control, cholesterol reduction, prescribe aspirin (if appropriate) and treat blood sugar until symptoms are controlled.

Only then will GPs really be responding to UKPDS and concentrating on patient-oriented evidence to the benefit of their patients.

Scott Pegler

Principal Pharmacist Medicines Information Manager

Swansea NHS Trust

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