UK
Diabetes Targets Too Aggressive?
New
targets set for diabetes treatment in Britain's National Health
Service may be too strict to be practical, an article in Friday's
British Medical Journal warns.
Many
patients are unlikely to achieve the guidelines, laid out in a new
National Service Framework (NSF), and meeting them will require some
patients to take an array of different drugs, according to Dr. Peter
Winocour of Queen Elizabeth II Hospital in Hertfordshire, England.
Targets
for managing blood sugar, cholesterol, blood pressure and anticlotting
medication have only been attainable in 50% to 70% of participants in
well-controlled studies, meaning that even fewer could be expected to
achieve them in routine practice, Winocour said.
And
in trying to achieve these guidelines, as well as others, it is likely
going to be necessary to give patients many different drugs, he added.
Up
to 10% of patients could need to take two or three drugs to lower
blood pressure, including insulin; at least three blood
pressure-lowering drugs; two drugs to cut cholesterol; and aspirin, he
explained. And many may need additional drugs for heart disease or
other types of chronic illness.
"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," Winocour said.
Individually
tailored targets that take into account factors such as estimated
duration of diabetes, obesity, age and lifestyle would be preferable,
he argues.
Dr.
Mike Pringle, of the University of Nottingham and co-chair of the
diabetes National Service Framework, argued that the framework's chief
concern was to help patients manage their disease.
"Many
patients are not receiving sufficient information and education about
their diabetes and are not put in a position to make informed choices
about their lifestyle and diet and exercise, and about treatment
options," he said.
"The
diabetes NSF is about systems of care and the most important standard
is standard number 3, which is about empowering patients to make good
decisions about how they will look after their own diabetes," he
told Reuters Health.
He
said the way in which the diabetes NSF is implemented was crucial.
"It must recognize patients' choice; it must recognize the
natural variations in performance that occur; and it must identify and
reward good practice in supporting patients to make informed choices
about their care."
Kristina
Sandstedt,
MS,
Clinical
Exercise
Physiologist,
Diabetes
Educator
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