'Waiting to fail' strategy in diabetes is 'bad medicine'

New diabetes therapies will help clinicians move away from management based on waiting for glucose control to fail before improving care, a leading researcher believes.

This will mean patients' HbA1c levels become more likely to remain within management targets, reducing risk of long-term vascular complications, according to Professor Anthony Barnett, clinical director of diabetes at Heart of England NHS Foundation Trust.

Professor Barnett said that the usual model of diabetes care has been brought under scrutiny by the development of new treatments, such as human glucagon-like peptide (GLP-1) analogues and dipeptidyl peptidase 4 (DPP-4) inhibitors.

The usual process was, he pointed out, based on 'waiting for failure', where each stage of therapy is only introduced when patients' HbA1c levels fail to fall below set targets.

'This means that the average type-2 diabetes patient spends about 75 per cent of his life as a diabetes patient well outside recommended targets,' he said. 'This "waiting for failure" concept is bad medicine and should not in any way be condoned.'

As soon as patients move outside their target HbA1c, additional therapies need to be introduced, he argued.

Older second-line agents, such as sulfonylureas, increased weight gain and hypoglycaemia.

'It is important to recognise that new drugs, such as the DPP-4 inhibitors, have the potential to improve glycaemic control with a low risk of hypoglycaemia and weight gain,' he said.

'In five years' time it will be interesting to see how treatment changes,' he said.

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