Intended for healthcare professionals

Rapid response to:

Primary Care

Randomised controlled trial of structured personal care of type 2 diabetes mellitus

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7319.970 (Published 27 October 2001) Cite this as: BMJ 2001;323:970

Rapid Response:

Re: The best therapy of diabetes mellitus type 2 and its complications is its primary prevention.

Dr. Stagnaro relates to the ongoing debate of prevention vs.
treatment. It is true, that the incidence of diabetes is increasing
because of developments in society, which means more plentiful and fattier
food, too little exercise and increasing overweight. Therefore, for
primary prevention we need to inspire our politicians to change the
direction of developments.

Since type 2 diabetes most often has an insidious start, we have up
to 150,000 people with undiagnosed diabetes in Denmark. This is 3% of the
population. To find the undiagnosed patients is a difficult task as it
remains to be seen that we can find a significant proportion of these
patients by screening a relatively small (e.g. 20%) proportion of the
population. I will be looking forward to read about Dr. Stagnaros model in
English.

However, among the approximately 130,000 Danes who have already been
diagnosed, there are still at least a quarter who are so badly regulated
that they run a very high risk of developing diabetic complications. Since
the resources in the health system are limited, we must of necessity focus
on effects and thereby also on where we can use the resources most
effectively. The study "Diabetes Care in General Practice" exemplifies
this.

Finally, Dr. Stagnaro questions the "newness" of our newly diagnosed
diabetic patients. The median time from the first suspicion was raised
until the first clinical examination in the study was about a week.

Yours sincerely,

Niels Olivarius

Competing interests: No competing interests

22 November 2001
Niels de Fine Olivarius
Associate Professor
Central Research Unit of General Practice, Panum Institute, DK-2200 Copenhagen N, Denmark