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Education And Debate

Effective diabetes care: a need for realistic targets

BMJ 2002; 324 doi: (Published 29 June 2002) Cite this as: BMJ 2002;324:1577
  1. Peter H Winocour (, consultant physician
  1. Department of Diabetes and Endocrinology, Queen Elizabeth II Hospital, Welwyn Garden City, Herts AL7 4HQ
  • Accepted 19 December 2001

The research based metabolic and blood pressure targets that the national service framework for diabetes in England and Wales will set in the implementation document will be impractical for use in routine clinical care: targets need to be tailored to the individual patient, according to Peter Winocour

The publication of the national service framework for diabetes in England and Wales will raise public awareness of diabetes throughout the United Kingdom. Its recommendations are influenced by evidence that adverse vascular outcomes may be reduced by tight control of blood sugar and blood pressure13 and that secondary prevention of macrovascular disease is feasible through modification of dyslipidaemia and use of antiplatelet agents47w1; and by the recognition of an estimated doubling in incidence of diabetes over the next 10 years.8

This has led to the production of guidelines for optimal care that may be incorporated into a nationally recommended standardised approach, with targets for metabolic and vascular variables and recommendations for certain therapies.911w2 The effectiveness and quality of healthcare systems are increasingly being measured by how well such standards are adhered to, and it is therefore vital that the targets are appropriate. The following discussion focuses on type 2 diabetes, since this is much more common than type 1 diabetes.

Summary points

Aggressive treatment of hyperglycaemia, dyslipidaemia, and hypertension and regular use of antiplatelet agents has been advocated in type 2 diabetes

Current targets for glycaemia, lipids, and blood pressure are attainable in only 50-70% of individuals in research studies

The targets are often impractical and involve taking too many drugs, with which patients often will not comply

Individually tailored targets are needed, and their effectiveness will be shown by improvement in the range of metabolic and blood pressure measurements in diabetic …

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