Intended for healthcare professionals

Clinical Review

Prevention and early detection of vascular complications of diabetes

BMJ 2006; 333 doi: (Published 31 August 2006) Cite this as: BMJ 2006;333:475

Who says?

This review of the prevention of vascular complications of diabetes
contributes to the volume of slightly differing guidelines around best
management of diabetes. Aside from whether it added anything to the range
of international guidance available, it was most notable in its
uncompromisingly didactic recommendations; challenging targets for blood
pressure and blood glucose control were suggested and bold statements were
made about the use of statins in every patient with diabetes who is over
40. No doubt as diabetic specialists this makes sense; as a GP who treats
patients who have diabetes, perhaps amongst many conditions, it left me no
further forward.

What should a patient with diabetes chose to do, especially if they
are more concerned about their low mood or painful knee? What degree of
benefit would they expect (number needed to treat in other words)? How can
I, as their advisor, outline the benefits and harms when they complain
about polypharmacy ("not another pill doctor")?

A better use of the authors time might have been to translate current
recommendations into useable advice to counsel patients so that they can
actively participate in shared decisions; this is especially so with a
long term condition such as diabetes where we only pay such a fleeting
part in the patients life and only they can decide on a gloomy Saturday
evening whether to take that cholesterol tablet or not.

Competing interests:
None declared

Competing interests: No competing interests

05 September 2006
Tim Wilson
Mill Stream Surgery, Benson, OX10 6LA