Public Release: 

Diabetes targets will be impractical in routine practice

Effective diabetes care: a need for realistic targets, BMJ Volume 324, pp 1577-80

BMJ

Targets due to be set as part of the national service framework for diabetes in England and Wales will be impractical for use in routine clinical care, according to an article in this week's BMJ.

Aggressive treatment of high levels of blood sugar, cholesterol, and blood pressure and regular use of antiplatelet drugs has been advocated in type 2 diabetes. Yet current targets are attainable in only 50-70% of individuals in research studies, argues Peter Winocour of Queen Elizabeth II Hospital in Hertfordshire.

The targets are often impractical and involve taking too many drugs, with which patients often will not comply, he adds. Individually tailored targets would be preferable, taking account of factors such as estimated duration of diabetes, obesity, age and lifestyle.

Given the cardiovascular risk profile of type 2 diabetes, up to 10% of patients could require as many as nine drugs. A high proportion will also require treatment for existing heart disease and coincidental unrelated chronic disease, says the author. "It is difficult to see how we can realistically expect patients to comply for long with such a draconian regimen requiring so many separate drugs."

He concludes: "The development of combination tablets by the pharmaceutical industry seems of the utmost priority for effective prevention of complications of type 2 diabetes. Until then we must be pragmatic. We should set targets that are reasonable for our clinics and our individual patients."

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