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'Strip GPs of any right to a choice over computers'

New research on diabetes suggests guidelines are not universally applied and highlights the importance of HbA1c ­ Brian Kelly reports

The vast majority of patients with diabetes are not receiving the lipid-lowering therapy they need, according to a new study of UK general practice.

Only a fifth of patients with type 2 diabetes were prescribed a statin and just a quarter of those who also had macrovascular disease, according to the study.

NICE recommends all patients with diabetes and a cardiac risk of 15 per cent over 10 years should receive a statin.

The researchers called their findings 'disconcerting' but GPs said changes in practice were under way and would be accelerated by the new contract.

Of 8,686 type 2 diabetes patients in the study, 39 per cent had coronary heart disease, angina, stroke or peripheral arterial disease, collectively classified as macrovascular disease.

Just 18 per cent overall and 27 per cent with macrovascular disease received statins. Patients over the age of 70 were only half as likely as younger patients to get the drugs.

The researchers also studied 1,128 patients with type 1 diabetes and found just 39 per cent of those with macrovascular disease were prescribed statins.

Research leader Professor Andrew Morris, professor of clinical pharmacology at the University of Dundee, said: 'We have found a clear gap between those requiring lipid-lowering drug therapy and those actually taking it.

'Current practice is generally well below recommended levels. To improve secondary prevention, clinical teams need to adopt a proactive attitude towards identification and initiation of treatment.'

But Dr Roger Gadsby, treasurer of the Primary Care Diabetes Group and a GP in Nuneaton, Warwickshire, said: 'It takes time for primary care to implement change as people with diabetes may only be seen every six or 12 months.

'With the new quality and outcomes framework I am sure it will make a huge difference in statin prescribing as GPs want to get cholesterol below five.'

Dr Gadsby added that the recent CARDS trial had strengthened the case for more extensive use of statins in diabetes patients and that NICE should modify its guidance.

The study, published in

Diabetes Medicine (October), analysed data from 385,500 residents of Tayside, Scotland.

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