Tag Archives: diabetes

Summary of therapies and key recommendations are: Insulin therapy (including the long-acting insulin analogues, insulin detemir, insulin glargine) Insulin detemir and insulin glargine, like NPH insulin, provide slowly-released insulin to meet basal requirements.  When the decision to start insulin is made, human NPH insulin should be started; healthcare professionals should consider switching to a long-acting insulin analogue if the patient experiences significant hypoglycaemia, is unable to use the device needed to inject NPH insulin, or needs help to inject the insulin from a carer or healthcare professional, and for whom switching to a lo

There was a 63% increase in the incidence of diabetes in the UK in the ten years between 1996 and 2005, a new study shows. The study, published online in the Journal of Epidemiology and Community Health, used data on 49,999 prevalent cases and 42,642 incident cases (1,256 type I diabetes and 41,386 type 2 diabetes) in UK patients aged 10 to 79 contained in The Health Improvement Network (THIN) database. During the 10-years examined, the prevalence increased from 2.8% to 4.3% while the incidence rose from 2.71 per 1,000 person-years to 4.42 per 1,000 person-years. Type 2 diabetes accounted for most of the increase, and the proportion of patie

New data on intensive glucose lowering in type 2 diabetes The results of three large trials investigating the clinical effects of intensive glucose lowering in patients with type II diabetes were presented at the recent American Diabetes Association meeting in San Francisco, USA, and have shown somewhat conflicting results. The ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial was stopped earlier this year because of an increased mortality in the intensive glucose lowering group. The two other trials – ADVANCE (Action in Diabetes and Vascular Disease – Preterax and Diamicron MR Controlled Evaluation) and VADT (Veteran’s A

The struggle to meet targets GPs are struggling to meet these targets, with only 56–59% of patients achieving HbA1c <7.5% in at least 50% of patients in 2004/5, and 59–62% of patients in 2005/6.6 While metformin has an excellent safety and efficacy record, and continues to be standard first-line therapy for all patients who can tolerate it, UKPDS has shown us that for most patients, multiple hypoglycaemic agents are necessary. Sulphonylureas are also well tried and tested, and relatively cheap, but carry the risk of weight gain and hypoglycaemia, especially with longer-acting versions such as chlorpropamide and glibenclamide. In additi

The ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial, conducted by the US National Heart, Lung, and Blood Institute (NHLBI), was stopped in February because the group being treated with intensive glucose lowering was showing a higher mortality rate than the group receiving standard treatment. But just days later, the group organising another similar trial, ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation), announced that preliminary results of their study did not confirm the adverse mortality trend with intensive treatment reported from the ACCORD study.

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