Intended for healthcare professionals

Clinical Review

Management of hyperglycaemia in type 2 diabetes: the end of recurrent failure?

BMJ 2006; 333 doi: (Published 07 December 2006) Cite this as: BMJ 2006;333:1200
  1. R J Heine, professor of diabetology1,
  2. M Diamant, associate professor of medicine1,
  3. J-C Mbanya, head of unit2,
  4. D M Nathan, director3
  1. 1Diabetes Centre, Department of Endocrinology, VU University Medical Centre, Amsterdam, De Boelelaan 1117, Netherlands
  2. 2Diabetes and Endocrine Unit, Department of Internal Medicine and Specialities, University of Yaounde, Cameroon
  3. 3Diabetes Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
  1. Correspondence to: R J Heine RJ.Heine{at}
  • Accepted 20 October 2006

The epidemic of type 2 diabetes imposes an enormous and growing burden on health care worldwide. The number of people with type 2 diabetes around the world is estimated to rise from 151 million in 2000 to 300 million by 2025.1 The recognition that strict glycaemic control can reduce microvascular complications has made the effective treatment of hyperglycaemia a priority.2 3 4 5 6 Recently, the diabetes control and complications trial reported that intensive therapy aimed at normoglycaemia has beneficial effects on cardiovascular disease in type 1 diabetes.7 In type 2 diabetes, epidemiological data from the UK prospective diabetes study suggest that lowering glycaemia will reduce the risk of cardiovascular disease.8 The treatment of hyperglycaemia in type 2 diabetes is complex; combinations of glucose lowering drugs are often needed to achieve and maintain blood glucose at target values. The development of new classes of drugs to lower blood glucose has increased the treatment options for type 2 diabetes and has contributed to the uncertainty surrounding these new therapeutic approaches. Here we present a management guideline that may help healthcare providers treat patients with type 2 diabetes.

Sources and selection criteria

This review is largely based on the recently published American Diabetes Association/European Association for the Study of Diabetes treatment guideline for type 2 diabetes.9 We also searched the Cochrane Library for evidence based guidelines using the keywords “type 2 diabetes”, “blood glucose lowering agents”, “glucose monitoring”, “lifestyle”, and “exercise and diet”

What level of glycaemic control should we aim for?

Studies have shown that the development of microvascular disease is reduced when glycaemic control is improved and have helped establish treatment targets for glycaemia in type 2 diabetes.4 6 Ideally glycated haemoglobin (HbA1C) should be as close to normal as possible without imposing a high risk of severe hypoglycaemia. The upper limit of normal of the …

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