'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.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

Five GP practices a week inspected by CQC during pandemic second wave

Five GP practices a week inspected by CQC during pandemic second wave

The CQC has inspected five GP practices a week in England since the second wave of...

Pregnant women and under-18s will not be offered COVID-19 vaccine

Pregnant women and under-18s will not be offered COVID-19 vaccine

Pregnant women, children and under-18s will not be recommended for routine COVID-19...

GP training: How an audit e-portfolio log entry is assessed

GP training: How an audit e-portfolio log entry is assessed

The second of two articles on audit during GP training looks at how the quality improvement...

GP training: Writing up an audit for your e-portfolio

GP training: Writing up an audit for your e-portfolio

In the first of two articles on how to write up an audit, a typical e-portfolio entry...

UK ups order of 95% effective COVID-19 vaccine by 2m doses

UK ups order of 95% effective COVID-19 vaccine by 2m doses

The UK has increased its order of the 95% effective Moderna COVID-19 vaccine to 7m...

Coronavirus: Key guidance GPs need to know about COVID-19

Coronavirus: Key guidance GPs need to know about COVID-19

GPonline provides an overview of the key guidance relating to coronavirus, including...