Issue 112 Item 9 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."