GPs should individualise their targets for patients with type 2 diabetes, with less intensive targets for older patients and those with ‘low motivation’.
The UK researchers assessed all major trials and systematic reviews of intensive versus standard glycaemic control with HbA1c targets of greater than or equal to 42mmol/mol (6%), 48mmol/mol (6.5%), 53mmol/mol (7%), or 58mmol/mol (7.5%). These included the ACCORD, ADVANCE and PROactive trials.
They found the trials showed intensive glycaemic control had some benefits in terms of reducing mortality and macrovascular and microvascular disease, compared with standard control. But this came with an increased risk of severe hypoglycaemia in patients who were older or had existing cardiovascular complications.
A recent Cochrane systematic review found that intensive glycaemic control did not have any significant effect on the risk of all-cause or cardiovascular mortality, but the risk of severe hypoglycaemia was doubled in those receiving intensive management, versus those with standard diabetes care.
What this means for GPs
The authors concluded that individual targets should be determined ‘with consideration of the patient’s clinical factors’, including life expectancy, psychosocial factors, co-morbidities, duration of disease and risk of hypoglycaemia.
They added: ‘The most stringent targets might be appropriate for people with a short duration of disease, long life expectancy, no co-morbidities, a low risk of hypoglycaemia, adequate support systems, and high motivation.
‘The least intensive targets might be appropriate for older patients with a long history of diabetes, multiple or severe complications or co-morbidities, poor self-care capability and support, and low motivation.’
Pulse Live: 30 April – 1 May, Birmingham
Professor Martin Stevens, professor of medicine at the University of Birmingham, will look at the new developments in diabetes at Pulse Live, Pulse’s new two-day annual conference for GPs, practice managers and primary care managers.
Pulse Live offers practical advice on key clinical and practice business topics, as well as an opportunity to debate the future of the profession, and a top range of speakers includes NICE chair designate Professor David Haslam, GPC deputy chair Dr Richard Vautrey and the Rt Hon Stephen Dorrell MP, chair of the House of Commons health committee.
To find out more and book your place, please click here.