Tight control of blood glucose in long standing type 2 diabetes

doi:10.1136/bmj.b800

Published 5 March 2009, doi:10.1136/bmj.b800
Cite this as: BMJ 2009;338:b800

Editorials

Tight control of blood glucose in long standing type 2 diabetes

Reducing glycated haemoglobin below 7% is not supported by evidenceand may even be harmful

The first 150 words of the full text of this article appear below.

During the past year, three important studies have providedevidence that tighter glycaemic control (to <7% glycatedhaemoglobin) in older adults with type 2 diabetes does not providesubstantial benefit and may increase the risk of adverse outcomes.These findings, which some experts and policy makers found surprising,should lead to the re-evaluation of recommendations about whatconstitutes high quality care for these patients.

The management of type 2 diabetes in the United Kingdom takesplace largely in primary care and is strongly influenced bythe requirements of the quality and outcomes framework (QOF)—anannual reward and incentive programme, which although voluntaryprovides a substantial proportion of general practitioners’income. From April 2009, general practitioners in the UK willneed to reduce glycated haemoglobin in half of their patientswith type 2 diabetes to below 7% to earn the same amount thatthey are currently paid for achieving a target . . . [Full text of this article]

Richard Lehman, general practitioner¹, Harlan M Krumholz, Harold H Hines Junior professor of medicine and epidemiology and public health²

¹ Hightown Surgery, Banbury OX16 9DB, ² Section of Cardiovascular Medicine and Robert Wood Johnson Clinical Scholars Program, Department of Medicine, Section of Health Policy and Administration, School of Public Health, Yale University School of Medicine, PO Box 208088, New Haven, CT 06520-8088, USA

richard.lehman@nhs.net

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This article has been cited by other articles:

Griffin, S., Graffy, J. (2009). New QOF glycaemia targets are achievable and evidence based. BMJ 338: b1915-b1915 [Full text]
Willis, T. (2009). Time to abolish QOF. BMJ 338: b1916-b1916 [Full text]
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Rapid Responses:

Read all Rapid Responses

Aim for good evidence based targets: Rupert A Gude
bmj.com, 11 Mar 2009 [Full text]
Hypoglycemia in the patients with long lasting T2DM: Gauranga C. Dhar
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The individual patient should decide what their target hbaic should be.: Katharine M Morrison
bmj.com, 12 Mar 2009 [Full text]
Hidden dangers in rebound hyperglycaemia.: Richard G Fiddian-Green
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Whose idea was this ?: Harry Hall
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Re: Hidden dangers in rebound hyperglycaemia.: Gauranga C. Dhar
bmj.com, 13 Mar 2009 [Full text]
In defence of QOF targets: Richard A Brice
bmj.com, 13 Mar 2009 [Full text]
Sensible, evidence-based QoF targets: Peter D Burrill
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New QOF glycaemia targets are achievable and based on a balanced review of available evidence: Simon J Griffin, et al.
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Glycaemic targets in diabetes: It's time to put patients first.: Jyothis George, et al.
bmj.com, 19 Apr 2009 [Full text]
Ethics of QOF: Edward TJ Chandy
bmj.com, 19 Apr 2009 [Full text]
Re: Ethics of QOF: L Sam Lewis
bmj.com, 19 Apr 2009 [Full text]
No competing interests - who are you kidding: ted willis
bmj.com, 20 Apr 2009 [Full text]
Re: Glycaemic targets in diabetes: It's time to put patients first.: Angus H N Whitfield
bmj.com, 20 Apr 2009 [Full text]
Re: Re: Ethics of QOF: Mark Struthers
bmj.com, 20 Apr 2009 [Full text]
Re: Re: Re: Ethics of QOF: L Sam Lewis
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Re: Re: Re: Re: Ethics of QOF: Edward TJ Chandy
bmj.com, 21 Apr 2009 [Full text]
Re: Re: Re: Re: Re: Ethics of QOF: L Sam Lewis
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Re: Re: Re: Re: Re: Ethics of QOF: Harry Hall
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Re: Re: Re: Re: Re: Re: Ethics of QOF: Tracy Monk
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Is hyperinsulinemia the culprit for worse results orf aggressive glucose control?: Wenyi Yang
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Re: Re: Re: Re: Re: Re: Re: Ethics of QOF: Jonathan P Richards
bmj.com, 25 Apr 2009 [Full text]
Time for Patient-driven goals?: Mark E McConnell
bmj.com, 1 May 2009 [Full text]
Definitions of 'tight control' are not consistent.: David K Lewis
bmj.com, 12 May 2009 [Full text]